Table 4.

Drugs for Which the Effect on Nursing Infants Is Unknown but May Be of Concern*

DrugReported or Possible EffectReference No.
Anti-anxiety
 AlprazolamNone 57
 DiazepamNone58–62
 LorazepamNone 63
 Midazolam 64
 PerphenazineNone 65
 Prazepam None 66
 QuazepamNone 67
 Temazepam 68
Antidepressants
 AmitriptylineNone69, 70
 AmoxapineNone 71
 BupropionNone 72
 ClomipramineNone 73
 DesipramineNone74, 75
 DothiepinNone76, 77
 DoxepinNone 78
 FluoxetineColic, irritability, feeding and sleep disorders, slow weight gain79–87
 Fluvoxamine 88
 ImipramineNone 74
 NortriptylineNone89, 90
 ParoxetineNone 91
 Sertraline None92, 93
 TrazodoneNone 94
Antipsychotic
 ChlorpromazineGalactorrhea in mother; drowsiness and lethargy in infant; decline in developmental scores95–98
 ChlorprothixeneNone 99
 Clozapine None100
 HaloperidolDecline in developmental scores101–104
 MesoridazineNone105
 TrifluoperazineNone104
OTHERS
AmiodaronePossible hypothyroidism106
ChloramphenicolPossible idiosyncratic bone marrow suppression107, 108
ClofaziminePotential for transfer of high percentage of maternal dose; possible increase in skin pigmentation109
LamotriginePotential therapeutic serum concentrations in infant110
Metoclopramide None described; dopaminergic blocking agent111, 112
MetronidazoleIn vitro mutagen; may discontinue breastfeeding for 12–24 h to allow excretion of dose when single-dose therapy given to mother113, 114
TinidazoleSee metronidazole115
  • * Psychotropic drugs, the compounds listed under anti-anxiety, antidepressant, and antipsychotic categories, are of special concern when given to nursing mothers for long periods. Although there are very few case reports of adverse effects in breastfeeding infants, these drugs do appear in human milk and, thus, could conceivably alter short-term and long-term central nervous system function.56 See discussion in text of psychotropic drugs.

  • Drug is concentrated in human milk relative to simultaneous maternal plasma concentrations.