Hale’s Medications & Mothers’ Milk
A Manual of Lactational Pharmacology
Appendix
Contents
Using Radiopharmaceutical Products in Breastfeeding Mothers
Using radioactive products in breastfeeding mothers must be approached with great care and significant knowledge. Invariably, the administration of a radiopharmaceutical to a lactating mother will result in some transfer of radioactivity into her milk. In addition, the radiation energy from some gamma rays can, with some isotopes, radiate from the mother body out to 6 feet, exposing the infant to what we call close contact radiation. The relative dose received by the infant is dependent on a number of factors, but most importantly by the radioactive dose administered, the relative “energy” of the radioisotope, the biological and radioactive half-life of the product, and the amount that enters milk. Most important of these is the radioactive energy of the gamma ray. Some are weak (technetium) and some are quite strong (iodine-131).
The following tables present data from some of the best sources in the world and provides their recommendations on interrupting breastfeeding to allow for the decay and/or clearance of the radiopharmaceutical. Most of their decisions were based on the probable radioactive “dose” transferred to the infant, and whether or not it was considered hazardous. Please note that some of their recommendations conflict. Ultimately the mother and her radiologist will have to assess the relevance of these data in their specific situation.
When evaluating radiopharmaceuticals, it is important to understand that all of these products have “two” half-lives. One is the radioactive half-life of the isotope. This half-life is set and invariable. While we prefer shorter half-life products like 99mTechnetium (6.02 hours), many other isotopes have important uses in medicine. The second half-life is the ‘biological’ or ‘effective’ half-life of the specific product. Many of these products are rapidly eliminated from the body via the kidney, some within minutes to hours. Thus the “biological or effective” half-life is critical and sometimes is so fast that the radiopharmaceutical is gone from body long before its isotope is decayed (see 111In-Octreotide). However, some isotopes such as the radioactive iodides (131I, 125I) may be retained in the body for long periods and present extraordinary hazards to the breastfeeding infant.
Lastly, two units of radioactivity are commonly used by differing sources. Just remember that one mCi (millicurie) is equal to 37
Lastly, this subject is so important to the breastfed infant, that I would suggest you call the InfantRisk Center first, to be sure that the information you are given by the radiologist is accurate for breastfeeding women.
Some important points to remember about evaluating these products in breastfeeding mothers:
Use the weakest and shortest half-life product permitted, such as 99mTechnetium. Its half-life is so short, and its radioactive emissions are so weak, that it poses little risk (but this depends on dose). While the table that follows frequently does not even suggest interrupting breastfeeding, we still suggest that waiting even 12-24 hours before breastfeeding would virtually eliminate all possible risks associated with this isotope.
Regardless of the isotope used, if the dose is extremely high, then withholding breastfeeding for a minimum of five to as many as ten radioactive half-lives is probably advisable.
Measuring the radioactivity present in milk is the most accurate way to determine risk. This often requires sophisticated equipment not available in most hospitals, but it is the “final” determinant of risk to the infant. If the isotope present in milk approaches ‘background’ levels, there is no risk to the infant.
Use great caution before returning to breastfeeding if the radioactive Iodides are used. Iodine is selectively concentrated in the thyroid gland. The lactating breast with receive up to 27% of administered dose. The transfer of such high doses into milk and the infant could potentially lead to thyroid cancer in the infant. 131I and 125I are potentially of high risk due to their long radioactive half-lives, the high energy of their radioactive particles, and their high affinity for thyroid tissues. 123I has a much shorter half-life, and brief interruptions may eliminate most risks. In mothers who have had their thyroid removed, the return to breastfeeding will be much quicker, but moms need to withholod breastfeeding for some time.
Further even close contact can produce high radiation exposure to an individual in close contact with the individual. Thus we have added comments regarding close contact restrictions under the breastfeeding interruption section in the Radioisotope table.
Because radioactivity decays at a set rate, milk can be stored in the freezer for at least eight to ten half-lives and then fed to the infant without problem. All of the radioactivity will be gone.
Typical Radioactive Half-Lives
| Radioactive Element | Radioactive Half-Life |
|---|---|
| 99Mo | 2.75 Days |
| 201 | 3.05 Days |
| 201 | 73.1 Hours |
| 67Ga | 3.26 Days |
| 67Ga | 78.3 Hours |
| 131I | 8.02 Days |
| 133Xe | 5.24 Days |
| 111In | 2.80 Days |
| 51Cr | 27.7 Days |
| 125I | 60.1 Days |
| 89Sr | 50.5 Days |
| 99mTc | 6.02 Hours |
| 123I | 13.2 Hours |
| 153Sm | 47.0 Hours |
Radioisotopes in Lactation
When assessing the use of a radioisotope in lactation, it is important to know that the International Commission on Radiological Protection (
| Radiopharmaceutical | Activity administered to women in lactation studies ( | Effective half-time (h) | Total fraction excreted in milk: % injected activity | Infant dose in milk (mSvinfant/ | Mean infant dose via milk and/or contact | Breastfeeding interruption |
|---|---|---|---|---|---|---|
| 11C-Way 100635 | 526 | 0.3 | 2.7 µSv milk | No | ||
| 11C-Raclopride | 384 | 0.3 | 0.6 µSv milk | No¶ | ||
| 111In-Octreotide | 6 days | |||||
| 111In- | 6 days | |||||
| 133Xe Gas | No | |||||
| 11C-labelled | No | |||||
| 11N-labelled | No | |||||
| 11O-labelled | No | |||||
| 13N-labelled | No | |||||
| 15O-labelled | No | |||||
| 22Na | >3 weeks | |||||
| 75Se-labelled | >3 weeks | |||||
| 18F- | 277, 422 | 1.8 (1.7-1.8) | 0.07 (0.068-0.071) | 6.7 x 10-4 | No‖ | |
| 201Tl-chloride | 48 h | |||||
| 51Cr- | 3.7 | 6.1 (4.9-7.2) | 0.065 (0.018-0.11) | 2.1 x 10-4 | No | |
| 123I- | 0-3 days# | |||||
| 123I- | 0-3 days# | |||||
| 123I-Iodohippurate | 12 h | |||||
| 123I- | 0-3 days# | |||||
| 123I | No# | |||||
| 123I-NaI | Dose dependent. £3 days# | |||||
| 125I- | >3 weeks | |||||
| 125I-Iodohippurate | 0.4 | 5 | 2 | 1 | 12 h | |
| 131I-Iodohippurate | 0.28-0.66 | 6.3 (4.5-7.6) | 2.4 (1.1-4.3) | 5.3 | 12 h | |
| 131I- | >3 weeks | |||||
| 131I-NaI | 1-1.85 | 14 (10-17) | 31 (13-48) | 68 | Cessation | |
| 131I-NaI | 40 | 3930.4 mSv milk 0.68 mSv contact | Cessation | |||
| 131I-NaI | 5200 | 11.02 | 23.12 | 510952 mSv milk 88.18 mSv contact | Cessation | |
| 67Ga Citrate | 185 | 51.12 (15.92-64.78) | 7.23 (3.16-9.89) | 77.75 mSv milk 0.97 mSv contact | 3-4 weeks, less with low doses. When possible, consider monitoring milk activity before restarting. | |
| 14C-Glycocholic acid ( | 0.2 | 143 | 9.2 | 6.9 x 10-1 | No | |
| 14C-Triolein | 0.065 | 15 | 14 | 4.1 | No | |
| 14C-Urea | No | |||||
| 99mTc Diisopropyl iminodiacetic acid ( | 150 | 5.51(3.76-9.14) | 0.16 (0.1-0.28) | 0.14 mSv milk 0.11 mSv contact | No^; consider discarding 1st feed | |
| 99mTc Dimercaptosuccinic acid ( | No*^ | |||||
| 99mTc Diethylenetriamine-pentaacetic acid ( | 151, 190, 600 | 4.53 (3.13-5) | 0.12 (0.012-0.24) | 2.2 x 10-5 | 0.48 mSv milk 0.7 mSv contact One outlying case: 16.12 mSv milk 0.7 mSv contact | Yes (0-6 h)* ^; due to one outlying case with an exceptionally high effective dose (16.12 mSv) consider monitoring milk activity before restarting |
| 99mTc Ethylenedicysteine diester ( | No^; consider discarding 1st feed | |||||
| 99mTc Phosphonates ( | No*^ | |||||
| 99mTc Gluconate | 600 | 3.63 | 0.14 | 0.28 mSv milk 0.7 mSv contact | No^; consider discarding 1st feed | |
| 99mTc Glucoheptonate | No^ | |||||
| 99mTc Sulphur colloids | 100 | 6.23 (5.12-8.3) | 0.67 (0.16-1.48) | 0.5 mSv milk 0.12 mSv contact | Yes (0-6 h)† ^ | |
| 99mTc | 545, 602 when pretreated | 6.7 | 0.0057 | 6.7 x 10-6 | Yes (12 h)†; Limit close contact to 5 h in 24 h | |
| 99mTc | 800 | 8.37 (7.76-8.99) | 0.02 (0.02-0.03) | 0.08 mSv milk 1.25 mSv contact | No^; consider discarding 1st feed | |
| 99mTc | 12 h‡ | |||||
| 99mTc | 228 | 7.5 | 0.11 | 2 x 10-4 | No^; consider discarding 1st feed | |
| 99mTc Microspheres ( | 100 | 5.31(3.02-7.01) | 4.33 (0.88-11.34) | 3.87 mSv milk 0.08 mSv contact | Yes (12-24 h)‡ | |
| 99mTc Macroaggregated albumin ( | 60-104 | 4 (3.5-4.7) | 3.7 (0.51-8.5) | 7 x 10-3 | Yes (12 h) | |
| 99mTc | 52-68 | 4.2 (3.6-4.9) | 0.073 (0.02-0.1) | 1.4 x 10-4 | No^; consider discarding 1st feed | |
| 99mTc | 600 | 3.6 | 0.027 | 5.2 x 10-5 | No^; consider discarding 1st feed | |
| 99mTc | 360-379 | 4.9 (4.6-5.2) | 0.01 (0.0084-0.011) | 1.2 x 10-5 | No^; consider discarding 1st feed | |
| 99mTc | 480, 586, 900 | 5.5 (4.49-6.73) | 0.02 (0.01-0.03) | 0.08 mSv milk 1.4 mSv contact | No^; Limit close contact to 5 h in 24 h | |
| 99mTc Pertechnetate (not blocked) | 102-207 | 4.15 (2.23-8.26) | 12.18 (0.56-24.36) | 1.9 x 10-2 | 8.28 mSv milk 0.012 mSv contact | Yes (12-30 h)‡ |
| 99mTc Pertechnetate (blocked) | 360, 500 | 5.2 (4.5-5.9) | 0.82 (0.68-0.95) | 9.6 x 10-4 | Yes (12 h)‡ | |
| 99mTc Pyrophosphate ( | 600 | 4.86 (3.54-6.83) | 0.28 (0.15-0.44) | 0.91 mSv milk 0.47 mSv contact | Yes (0-8 h)*^; suggest feed interruption to reduce exposure without limiting contact | |
| 99mTc Tetrofosmin | 556 | 4.8 | 0.082 | 1.5 x 10-4 | No*^ | |
| 99mTc Technegas | No^; consider discarding 1st feed |
*
†
‡
‖
¶Interruption for 2 hours would eliminate almost all risk.[3]
^An interruption of 4 hours (one feed) may not be necessary for all 99mTc products but could be advised.[1,10]
#Historically, an interruption of breastfeeding of 3 weeks was recommended for all 123I labelled products due to contamination with 125I, a product with a significantly longer half life. Current production methods no longer contaminate 123I with 125I, and the breastfeeding interruption has been relaxed to 3 days.[8]
References:
- 1.Mattsson S, Johansson L, Svegborn S et al. Radiation dose to patients from radiopharmaceuticals: a compendium of current information related to frequently used substances. Annex D. Recommendations on breast-feeding interruptions. Ann ICRP. 2015;44(2Suppl):319–21.
- 2.Rubow S, Klopper J, Wasserman H et al. The excretion of radiopharmaceuticals in human breast milk: additional data and dosimetry. European Journal of Nuclear Medicine. 1994;21:144–53.
- 3.Moses-Kolko EL, Meltzer CC, Helsel JC et al. No interruption of lactation in needed after (11)C-WAY 100635 or (11)C-raclopride PET. J Nucl Med. 2003. Oct;46(10):1765.
- 4.Pullar M, Hartkamp A. Excretion of radioactivity in breast milk following administration of an 113-Indium labeled chelate complex. Br J Radial. 1977; 50:846.
- 5.Leide-Svegborn S, Ahlgren L, Johansson L et al. Excretion of radiopharmaceuticals in human breast milk after nuclear medicine examinations. Biokinetic and dosimetric data and recommendations on breastfeeding interruption. Eur J Nucl Med Mol Imaging. 2015: DOI 10.1007/s00259-016-3326-4.
- 6.Mountford PJ, O’Doherty MJ, Forge NI, Jeffries A, Coakley AJ. Radiation dose rates from adult patients undergoing nuclear medicine investigations. Nucl Med Commun. 1991. Sep;12(9):767–77.
- 7.Howe DB, Beardsley M, Bakhsh S. Appendix U. Model Procedure for Release of Patients or Human Research Subjects Administered Radioactive Materials. NUREG1556. Consolidated guidance about materials licenses. Program-specific guidance about medical use licenses. Final report. U.S. Nuclear Regulatory Commission Office of Nuclear Material Safety and Safeguards. 2008;9, Rev. 2. https://www.nrc.gov/docs/ML0734/ML073400289.pdf
- 8.Dilsizian V, Metter D, Palestro C, et al. Advisory Committee on Medical Uses of Isotopes (ACMUI) Sub-Committee on Nursing Mother Guidelines for the Medical Administration of Radioactive Material. Final report submitted: January 31, 2019. https://www.nrc.gov/docs/ML1903/ML19038A498.pdf.
- 9.American Academy of Pediatrics (AAP), Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001; 108(3):776–89.
- 10.American Academy of Pediatrics Committee on Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013;132(3):796–809.
- 11.International Atomic Energy Agency (IAEA). Radiation Protection and Safety in Medical uses of Ionizing Radiation, Specific Safety Guides. Appendix III, Cessation of Breastfeeding. 2018.
- 12.Bartick M, Hernández-Aguilar MT, Wight N, et al. ABM Clinical Protocol #35: Supporting Breastfeeding During Maternal or Child Hospitalization. Breastfeed Med. 2021;16(9):664–674.
Radioactive 131Iodine Close Contact Restrictions
Treatment of Hyperthyroidism (assuming 50% uptake)*,**
| Radiation dose | 370 (10 mCi) | 555 (15 mCi) | 740 (20 mCi) | 1110 (30 mCi) |
|---|---|---|---|---|
| Sleeping restriction (6 feet separation sleeping arrangement) for adults. | 3 nights | 6 nights | 8 nights | 11 nights |
| Sleeping restriction (6 feet separation of sleeping arrangement) for infants, children, and pregnant women. | 15 nights | 18 nights | 20 nights | 23 nights |
| Close contact restriction (6 feet separation) for children and pregnant women. | 1 day | 1 day | 2 days | 5 days |
Treatment of Thyroid Cancer Remnant Ablation (assuming 2% uptake) (No thyroid)*,**
| Radiation dose | 1850 (50 mCi) | 3700 (100 mCi) | 5550 (150 mCi) | 7400 (200 mCi) |
|---|---|---|---|---|
| Sleeping restriction (6 feet separation sleeping arrangement) for adults. | 1 night | 1 night | 2 nights | 4 nights |
| Sleeping restriction (6 feet separation of sleeping arrangement) for infants, children, and pregnant women. | 6 nights | 13 nights | 18 nights | 21 nights |
| Close contact restriction (6 feet separation) for children and pregnant women. | 1 day | 1 day | 1 day | 1 day |
Adapted from American Thyroid Association Taskforce On Radioiodine Safety, Sisson JC, Freitas J, McDougall IR, Dauer LT, Hurley JR, Brierley JD, Edinboro CH, Rosenthal D, Thomas MJ, Wexler JA, Asamoah E, Avram AM, Milas M, Greenlee C. Radiation safety in the treatment of patients with thyroid diseases by radioiodine 131I: practice recommendations of the American Thyroid Association. Thyroid 2011 Apr;21(4):335-46.
* IMPORTANT: The recommendations in the table above were derived by calculating the dose and time required to limit the effective dose to the infant below 1 mSv. Please be advised, these recommendations still permit a minimal amount of radiation transfer to the infant that is considered safe by the authorities. An average adult American is exposed to 6.2 mSv/year according to the Nuclear Regulatory Commission. The only way to totally avoid any radiation is to wait for all of it to decay (5-10 half-lives). Exposure of 1 mSv slightly increases the incidence of cancer to 1 in 10,000 people.
** The half-life of 131I is around 8 days. To avoid all radiation exposure to the breastfed infant, close contact must be avoided for at least 5 half-lives, i.e. 40 days.
Commonly Used Antidepressants: Suitability in Lactation
| Drug Name | Half-Life | Adult Dose | Relative Infant Dose | Lactation Risk Category |
|---|---|---|---|---|
| AMITRIPTYLINE | 31-46 h | 10-300 mg daily (varies by indication) | 1.08%-2.8% | L2 - Limited Data-Probably Compatible |
| BREXANOLONE | 9 h | Administered | 1%-2% | L2 - Limited Data-Probably Compatible |
| BUPROPION | 8-24 h | 150 mg twice a day Sustained Release | 0.11%-1.99% | L3 - Limited Data-Probably Compatible |
| CITALOPRAM | 36 h | 20-40 mg daily | 3.56%-5.37% | L2 - Limited Data-Probably Compatible |
| DESVENLAFAXINE | 11 h | 50-100 mg daily | 5.9%-9.3% | L3 - Limited Data-Probably Compatible |
| ESCITALOPRAM | 27-32 h | 10-20 mg daily | 5.2%-7.9% | L2 - Limited Data-Probably Compatible |
| FLUOXETINE | 2-3 days | 20-60 mg daily | 1.6%-14.6% | L2 - Limited Data-Probably Compatible |
| MIRTAZAPINE | 20-40 h | 15-45 mg daily | 1.6%-6.3% | L3 - Limited Data-Probably Compatible |
| PAROXETINE | 21 h | 20-50 mg daily | 1.2%-2.8% | L2 - Limited Data-Probably Compatible |
| SERTRALINE | 26 h | 50-200 mg daily | 0.4%-2.2% | L2 - Limited Data-Probably Compatible |
| VENLAFAXINE | 5 h | 75-225 mg daily Extended Release | 6.8%-8.1% | L2 - Limited Data-Probably Compatible |
| VORTIOXETINE | 66 h | 20 mg daily | 1.22%-1.85% | L3 - Limited Data-Probably Compatible |
Commonly Used Atypical Antipsychotics: Suitability in Lactation
| Drug Name | Half-Life | Adult Dose | Relative Infant Dose | Lactation Risk Category |
|---|---|---|---|---|
| ARIPIPRAZOLE | 75 h | 10-15 mg daily | 0.7%-6.44% | L3 - Limited Data-Probably Compatible |
| LURASIDONE | 18 h | 40-80 mg daily | 0.44% | L3 - No Data-Probably Compatible |
| OLANZAPINE | 21-54 h | 5-10 mg daily | 0.28%-2.24% | L2 - Limited Data-Probably Compatible |
| PALIPERIDONE | Oral 23 h; | 6 mg daily | Unknown | L3 - No Data-Probably Compatible |
| QUETIAPINE | 6 h | 300-800 mg daily | 0.02%-0.1% | L2 - Limited Data-Probably Compatible |
| RISPERIDONE | 20 h | 3 mg twice daily | 2.8%-9.1% | L2 - Limited Data-Probably Compatible |
| ZIPRASIDONE | 7 h | 20-80 mg twice daily | 0.07%-1.2% | L2 - Limited Data-Probably Compatible |
Commonly Used Benzodiazepines: Suitability in Lactation
| Drug Name | Half-Life | Adult Dose | Relative Infant Dose | Lactation Risk Category |
|---|---|---|---|---|
| ALPRAZOLAM | 12-15 h | 0.5-1 mg three times a day | 8.5% | L3 - Limited Data-Probably Compatible |
| CLOBAZAM | 36-42 h | 20-30 mg daily | 4.38%-5.33% | L3 - Limited Data-Probably Compatible |
| CLONAZEPAM | 18-50 h | 0.5-1 mg three times a day | 2.8% | L3 - Limited Data-Probably Compatible |
| DIAZEPAM | 43 h | 2-10 mg 2-4 times per day as needed | 0.88%-7.14% | L3 - Limited Data-Probably Compatible |
| LORAZEPAM | 12 h | 1 mg two-three times a day as needed | 2.6%-2.9% | L3 - Limited Data-Probably Compatible |
| MIDAZOLAM | 3 h | 1-2.5 mg | 0.63% | L2 - Limited Data-Probably Compatible |
| OXAZEPAM | 8 h | 10-30 mg 3-4 times a day | 0.28%-1% | L2 - Limited Data-Probably Compatible |
| TEMAZEPAM | 9.5-12.4 h | 7.5-30 mg daily | Unknown | L3 - Limited Data-Probably Compatible |
| TRIAZOLAM | 1.5-5.5 h | 0.125-0.25 mg daily | Unknown | L3 - No Data-Probably Compatible |
Commonly Used Opioid Analgesic Medications: Suitability in Lactation
| Drug Name | Half-Life | Adult Dose | Relative Infant Dose | Lactation Risk Category |
|---|---|---|---|---|
| BUPRENORPHINE | 2-3 h | 0.3 mg | 0.09%-2.52% | L2 - Limited Data-Probably Compatible |
| CODEINE | 2.9 h | 15-60 mg every 4-6 h as needed | 0.6%-8.1% | L3 - Limited Data-Probably Compatible |
| MORPHINE | 1.5-2 h | 10-30 mg oral; 5-15 mg | 9.09%-35% | L3 - Limited Data-Probably Compatible |
| TRAMADOL | 7 h | 50-100 mg every 4-6 h as needed | 2.86% | L3 - Limited Data-Probably Compatible |
| HYDROMORPHONE | 2-3 h oral immediate release & | 2-4 mg orally every 4-6 h as needed; 0.2-1 mg | 0.67% | L3 - Limited Data-Probably Compatible |
| FENTANYL | 2-4 h | 25-100 µg | 2.9%-5% | L2 - Limited Data-Probably Compatible |
| OXYCODONE | 2-4 h | 5-10 mg every 6 h as needed | 1.01%-4.55% | L3 - Limited Data-Probably Compatible |
| HYDROCODONE | 3.8 h | 5-10 mg every 6 h as needed | 2.21%-3.7% | L3 - Limited Data-Probably Compatible |
| *When possible acetaminophen and non-steroidal anti-inflammatories ( | ||||
Commonly Used Anesthetics: Suitability in Lactation
| Drug Name | Half-Life | Adult Dose | Relative Infant Dose | Lactation Risk Category |
|---|---|---|---|---|
| ATROPINE | 4.3 h | 0.6-1.2 mg every 6 h | Unknown | L3 - No Data-Probably Compatible |
| BUPIVACAINE | 2.7 h (Exparel longer) | 2.5 mg/kg max dose | 0.14%-2.92% | L2 - Limited Data-Probably Compatible |
| DEXAMETHASONE | 3.3 h | 0.5-9 mg daily | Unknown | L3 - No Data-Probably Compatible |
| DEXMEDETOMIDINE | 2 h | 1 µg/kg over 10 min., then 0.2-0.7 µg/kg/hour | Unknown | L2 - Limited Data-Probably Compatible |
| DIAZEPAM | 43 h | 2-10 mg 2-4 times a day as needed | 0.88%-7.14% | L3 - Limited Data-Probably Compatible |
| GLYCOPYRROLATE | 1.7 h | 10-20 mcg/kg | Unknown | L3 - No Data-Probably Compatible |
| KETAMINE | 2.5 h | Varies, 0.5-1 mg/kg | Unknown | L3 - No Data-Probably Compatible |
| KETOROLAC | 2.5 h | 15 mg every 6 h | 0.14%-0.2% | L2 - Limited Data-Probably Compatible |
| LIDOCAINE | 1.8 h | 4 mg/kg max dose | 0.5%-3.1% | L2 - Limited Data-Probably Compatible |
| LORAZEPAM | 12 h | 1 mg 2-3 times a day as needed | 2.6%-2.9% | L3 - Limited Data-Probably Compatible |
| MEPERIDINE | 2-4 h; active metabolite 15-30 h | 50-100 mg every 3-4 h as needed | 1.1%-13.3% | L4 - Limited Data-Possibly Hazardous |
| MIDAZOLAM | 3 h | 1-2.5 mg | 0.63% | L2 - Limited Data-Probably Compatible |
| ONDANSETRON | 3-4 h | 8 mg twice daily | Unknown | L2 - No Data-Probably Compatible |
| ROPIVACAINE | 4.2 h (epidural) | 3 mg/kg max dose | Unknown | L2 - Limited Data-Probably Compatible |
| SEVOFLURANE | 1.8-3.8 h | Variable | Unknown | L3 - No Data-Probably Compatible |
Commonly Used Migraine Medications: Suitability in Lactation
| Drug Name | Half-Life | Adult Dose | Relative Infant Dose | Lactation Risk Category |
|---|---|---|---|---|
| ALMOTRIPTAN | 3-4 h | 6.25-12.5 mg orally, may repeat in 2 h if needed | Unknown | L3 - No Data-Probably Compatible |
| ATOGEPANT | 11 h | 10-60 mg daily | Unknown | L3 - Limited Data-Probably Compatible |
| BUTALBITAL | 35 h | 50-100 mg every 4 h | Unknown | L3 - No Data-Probably Compatible |
| ELETRIPTAN | 4 h | 20-40 mg initially, may repeat in 2 h if needed | 0.02% | L3 - Limited Data-Probably Compatible |
| ERENUMAB | 28 days | 70-140 mg subcutaneously monthly | Unknown | L3 - No Data-Probably Compatible |
| ERGOTAMINE | 21 h | 2 mg every 30 min. (max 3 doses) | Unknown | L4 - Limited Data-Possibly Hazardous |
| FROVATRIPTAN | 26 h | 2.5 mg orally, may repeat in 2 h if needed | Unknown | L3 - No Data-Probably Compatible |
| NARATRIPTAN | 6-7 h | 1-2.5 mg orally, may repeat in 4 h if needed | Unknown | L3 - No Data-Probably Compatible |
| RIMEGEPANT | 11 h | 75 mg as needed per 24 h | 0.52% (single dose) | L2 - Limited Data-Probably Compatible |
| RIZATRIPTAN | 2-3 h | 5-10 mg orally, may repeat in 2 h if needed | Unknown | L3 - No Data-Probably Compatible |
| SUMATRIPTAN | 2-3 h | 25-100 mg orally, may repeat in 2 h if needed | 3.5% (single dose) | L3 - Limited Data-Probably Compatible |
| UBROGEPANT | 5-7 h | 20-100 mg, second dose at 2 h if necessary | Unknown | L3 - No Data-Probably Compatible |
| ZOLMITRIPTAN | 3 h | 2.5 mg orally, may repeat in 2 h if needed | Unknown | L3 - No Data-Probably Compatible |
Monoclonal Antibodies (Non-chemo): Suitability in Lactation
| Target Group | Target | Generic Name | Trade Names | Lactation Risk Category |
|---|---|---|---|---|
| Clotting | Factor IXa and Factor X | Emicizumab | Hemlibra | L3 - No Data-Probably Compatible |
| Clotting | Terminal complement protein C5 | Eculizumab | Soliris | L2 - Limited Data-Probably Compatible |
| Clotting | Terminal complement protein C5 | Ravulizumab | Ultomiris | L3 - No Data-Probably Compatible |
| Clotting | von Willebrand factor ( | Caplacizumab | Cabliva | L3 - No Data-Probably Compatible |
| External | B. anthracis toxins | Obiltoxaximab | Anthim | L3 - No Data-Probably Compatible |
| External | B. anthracis toxins | Raxibacumab | L3 - No Data-Probably Compatible | |
| External | C. diff. toxin B | Bezlotoxumab | Zinplava | L3 - No Data-Probably Compatible |
| External | dabigatran | Idarucizumab | Praxbind | L3 - No Data-Probably Compatible |
| External | Bamlanivimab | Emergency use authorization | L3 - No Data-Probably Compatible | |
| External | Casirivimab | Emergency use authorization | L3 - No Data-Probably Compatible | |
| External | Imdevimab | Emergency use authorization | L3 - No Data-Probably Compatible | |
| External | Sotrovimab | Xevudy | L3 - No Data-Probably Compatible | |
| Growth Factor | Burosumab | Crysvita | L3 - No Data-Probably Compatible | |
| Growth Factor | Teprotumumab | Tepezza | L3 - No Data-Probably Compatible | |
| Growth Factor | Bevacizumab | Avastin, Mvasi, Zirabev | L3 - No Data-Probably Compatible | |
| Growth Factor | Ranibizumab | Lucentis | L3 - No Data-Probably Compatible | |
| Immunicity | B lymphocyte stimulator protein | Belimumab | Benlysta | L3 - No Data-Probably Compatible |
| Immunicity | Mogamulizumab | Poteligeo | L3 - No Data-Probably Compatible | |
| Immunicity | Ocrelizumab | Ocrevus | L3 - No Data-Probably Compatible | |
| Immunicity | Rituximab | Rituxan | L3 - Limited Data-Probably Compatible | |
| Immunicity | Canakinumab | Citomix, Ilaris | L3 - No Data-Probably Compatible | |
| Immunicity | Ixekizumab | Taltz | L3 - No Data-Probably Compatible | |
| Immunicity | Secukinumab | Cosentyx | L3 - No Data-Probably Compatible | |
| Immunicity | Brodalumab | Siliq | L3 - No Data-Probably Compatible | |
| Immunicity | Anifrolumab | Saphnelo | L3 - No Data-Probably Compatible | |
| Immunicity | Daclizumab | Zinbryta | L3 - No Data-Probably Compatible | |
| Immunicity | Basiliximab | Simulect | L3 - No Data-Probably Compatible | |
| Immunicity | Guselkumab | Tremfya | L3 - No Data-Probably Compatible | |
| Immunicity | Risankizumab | Skyrizi | L3 - No Data-Probably Compatible | |
| Immunicity | Tildrakizumab | Ilumya | L3 - No Data-Probably Compatible | |
| Immunicity | Ustekinumab | Stelara | L3 - Limited Data-Probably Compatible | |
| Immunicity | Dupilumab | Dupixent | L3 - Limited Data-Probably Compatible | |
| Immunicity | Benralizumab | Fasenra | L3 - No Data-Probably Compatible | |
| Immunicity | Reslizumab | Cinqair | L3 - No Data-Probably Compatible | |
| Immunicity | Mepolizumab | Nucala | L3 - No Data-Probably Compatible | |
| Immunicity | Sarilumab | Kevzara | L3 - No Data-Probably Compatible | |
| Immunicity | Satralizumab | Enspryng | L3 - No Data-Probably Compatible | |
| Immunicity | Tocilizumab | Actemra | L3 - Limited Data-Probably Compatible | |
| Immunicity | Emapalumab | Gamifant | L3 - No Data-Probably Compatible | |
| Immunicity | Integrin, a4 | Natalizumab | Tysabri | L3 - Limited Data-Probably Compatible |
| Immunicity | Integrin, a4b7 | Vedolizumab | Entyvio | L3 - Limited Data-Probably Compatible |
| Immunicity | Etanercept | Enbrel | L2 - Limited Data-Probably Compatible | |
| Immunicity | Adalimumab | Humira, Imraldi | L3 - Limited Data-Probably Compatible | |
| Immunicity | Certolizumab Pegol | Cimzia | L2 - Limited Data-Probably Compatible | |
| Immunicity | Golimumab | Simponi | L3 - Limited Data-Probably Compatible | |
| Immunicity | Infliximab | Avsola, Inflectra, Remicade, Renflexis | L3 - Limited Data-Probably Compatible | |
| Lipids | Alirocumab | Praluent | L3 - No Data-Probably Compatible | |
| Lipids | Evolocumab | Repatha | L3 - No Data-Probably Compatible | |
| Migraine | Eptinezumab | Vyepti | L3 - No Data-Probably Compatible | |
| Migraine | Erenumab | Aimovig | L3 - No Data-Probably Compatible | |
| Migraine | Fremanezumab | Ajovy | L3 - No Data-Probably Compatible | |
| Migraine | Galcanezumab | Emgality | L3 - No Data-Probably Compatible | |
| Other | IgE | Omalizumab | Xolair | L2 - Limited Data-Probably Compatible |
| Other | kallikrein | Lanadelumab | Takhzyro | L3 - No Data-Probably Compatible |
| Other | P-selectin | Crizanlizumab | Adakveo | L3 - No Data-Probably Compatible |
| Other | Denosumab | Prolia, Xgeva | L3 - No Data-Probably Compatible | |
| Other | sclerostin | Romosozumab | Evenity | L3 - No Data-Probably Compatible |
Iodine Content From Various Natural Sources
| Iodine Sources | Descriptions | Quantity | Dose Form | Iodine Contents (mcg) | Percent of Daily Recommended Value |
|---|---|---|---|---|---|
| Bread[2] | White enriched | 2 slice | 45 | 30% | |
| Cheese[2] | Cheddar | 1 oz | 12 | 8% | |
| Cod[2] | 3 oz | 99 | 66% | ||
| Corn[2] | Creamy (canned) | 1/2 cup | 14 | 9% | |
| Egg[2] | 1 large | 24 | 16% | ||
| Fish sticks[2] | 3 oz | 54 | 36% | ||
| Fruit cocktail[2] | Heavy syrup | 1/2 cup | 42 | 28% | |
| Ice cream[2] | Chocolate | 1/2 cup | 30 | 20% | |
| Macaroni[2] | Enriched | 1 cup | 27 | 18% | |
| Milk[2] | 1 cup | 56 | 37% | ||
| Prunes[2] | Dried | 5 | 13 | 9% | |
| Iodized salt[2] | 3 g | 142 | 94% | ||
| Seaweed[1] | 1 g | 16-8165 | 11%-540% | ||
| Seaweed[1] | Arame | 1 g | 586 ± 56 | 391% | |
| Seaweed[1] | Bladderwrack | 1 g | 276 ± 82 | 184% | |
| Seaweed[1] | Dulse | 1 g | 72 ± 23 | 48% | |
| Seaweed[1] | Fingered tangle | 1 g | 1997 ± 563 | 1331% | |
| Seaweed[1] | Fingered tangle | 1 g | Granules | 8165 ± 373 | 5443% |
| Seaweed[1] | Hijiki | 1 g | 629 ± 153 | 419% | |
| Seaweed[1] | Horsetail tangle | 1 g | 30 ± 1 | 20% | |
| Seaweed[1] | Kelp | 1 g | Capsule | 1259 ± 200 | 839% |
| Seaweed[1] | Kelp | 1 g | 1513 ± 117 | 1009% | |
| Seaweed[1] | Kelp (wild) | 1 g | Capsule | 1356 ± 665 | 904% |
| Seaweed[1] | Kelp oarweed | 1 g | 746 ± 26 | 497% | |
| Seaweed[1] | Knotted wrack | 1 g | 646 ± 153 | 431% | |
| Seaweed[1] | Kombu | 1 g | 1350 ± 362 | 900% | |
| Seaweed[1] | Mekabu | 1 g | Tablet | 22 ± 1 | 15% |
| Seaweed[1] | Mekabu | 1 g | Powder | 53 ± 3 | 35% |
| Seaweed[1] | Mitthsuishi-kombu | 1 g | Powder | 2353 ± 65 | 1569% |
| Seaweed[1] | Nori | 1 g | Sheet | 16 ± 2 | 11% |
| Seaweed[1] | Oarweed | 1 g | 1862 ± 520 | 1241% | |
| Seaweed[1] | Paddle weed | 1 g | 2123 ± 352 | 1415% | |
| Seaweed[1] | Sea palm | 1 g | 871 ± 231 | 581% | |
| Seaweed[1] | Wakame | 1 g | 32-431 | 21%-287% | |
| Selenum[3] | 1 tablet | Tablet | 215 | 143% | |
| Shrimp[2] | 3 oz | 35 | 23% | ||
| Tuna[2] | Canned in oil | 3 oz | 17 | 11% | |
| Yogurt[2] | 1 cup | 75 | 50% |
References:
- 1.Teas J, Pino S, Critchley A, Braverman LE. Variability of iodine content in common commercially available edible seaweeds. Thyroid. 2004. Oct; 14(10): 836–41.
- 2.Iodine: Dietary Supplement Fact Sheet. National Institutes of Health, Office of Dietary Supplements. Updated 4/18/2011. Accessed 5/27/2011.
- 3.Arum SM, He X, Braverman LE. Excess iodine from an unexpected source. N Engl J Med. 2009. Jan 22; 360(4): 424–6.
Contraception Methods
See CONTRACEPTIVES - HORMONAL for details
| Trade name | Type | Estrogen | Progestin | Formulation | Comment |
|---|---|---|---|---|---|
| Alesse, Aviane, Lessina, Levlite, Lutera, Sronyx | Monophasic | Ethinyl estradiol 20 mcg | Levonorgestrel 0.1 mg | Oral | Avoid |
| Angeliq | Monophasic | Estradiol 1 mg | Drospirenone 0.5 mg | Oral | Avoid |
| Zoely, Stezza | Monophasic | 17 β-estradiol 1.5 mg | Nomegestrol acetate 2.5 mg | Oral | Avoid |
| Apri, Desogen, Emoquette, Ortho-Cept, Reclipsen, Solia | Monophasic | Ethinyl estradiol 30 mcg | Desogestrel 0.15 mg | Oral | Avoid |
| Aranelle, Leena, Tri-Norinyl | Triphasic | Ethinyl estradiol 35 mcg | Norethindrone 0.5 mg (days 1-7), 1 mg (days 8-16), 0.5 mg (days 17-21) | Oral | Avoid |
| Azurette, Kariva, Mircette | Biphasic | Ethinyl estradiol 20 mcg (days 1-21), 10 mcg (days 24-28) | Desogestrel 0.15 mg | Oral | Avoid |
| Balziva-28, Briellyn 28, Ovcon-35, Zenchent, Zeosa | Monophasic | Ethinyl estradiol 35 mcg | Norethindrone 0.4 mg | Oral | Avoid |
| Beyaz, Gianvi, Loryna, Yaz | Monophasic + levomefolate calcium 0.451 mg | Ethinyl estradiol 20 mcg (days 1-24) | Drospirenone 3 mg (days 1-24) | Oral | Avoid |
| Brevicon, Modicon, Necon 0.5/35, Nortrel 0.5/35 | Monophasic | Ethinyl estradiol 35 mcg | Norethindrone 0.5 mg | Oral | Avoid |
| Camila, Errin, Jolivette, Micronor, Nora- | Progestin only | Norethindrone 0.35 mg | Oral | Acceptable | |
| Caziant, Cesia, Cyclessa, Velivet | Triphasic | Ethinyl estradiol 25 mcg | Desogestrel 0.1 mg (days 1-7), 0.125 (days 8-14), 0.15 mg (days 15-21) | Oral | Avoid |
| Cryselle, Lo/Ovral, Low-Ogestrel | Monophasic | Ethinyl estradiol 30 mcg | Norgestrel 0.3 mg | Oral | Avoid |
| Demulen 1/35, Kelnor, Zovia 1/35 | Monophasic | Ethinyl estradiol 35 mcg | Ethynodiol diacetate 1 mg | Oral | Avoid |
| Depo-Provera | Progestin only | Medroxyprogesterone 150 mg every 3 months | Acceptable | ||
| Depo-SubQ Provera | Progestin only | Medroxyprogesterone 104 mg every 3 months | Acceptable | ||
| Enpresse, Levonest, Trivora | Triphasic | Ethinyl estradiol 30 mcg (days 1-6), 40 mcg (days 7-11), 30 mcg (days 12-21) | Levonorgestrel 0.05 mg (days 1-6), 0.075 mg (days 8-14), 0.15 mg (days 15-21) | Oral | Avoid |
| Triphasil | Triphasic | Ethinyl estradiol 30 mcg (days 1-6), 40 mcg (days 7-11), 30 mcg (days 12-21) | Levonorgestrel 0.05 mg (days 1-6), 0.075 mg (days 8-14), 0.125 mg (days 15-21) | Oral | Avoid |
| Estrostep 21, Tilia | Triphasic | Ethinyl estradiol 20 mcg (days 1-5), 30 mcg (days 6-12), 35 mcg (days 13-21) | Norethindrone 1 mg | Oral | Avoid |
| Estrostep Fe, Tilia Fe, Tri-Legest Fe | Triphasic/iron days 22-28 | Ethinyl estradiol 20 mcg (days 1-5), 30 mcg (days 6-12), 35 mcg (days 13-21) | Norethindrone 1 mg | Oral | Avoid |
| Femcon Fe, Zeosa Fe | Monophasic/iron days 22-28 | Ethinyl estradiol 35 mcg | Norethindrone 0.4 mg | Oral | Avoid |
| Gildess Fe, Junel Fe 1/20, Loestrin 24 Fe 1/20, Microgestin Fe 1/20 | Monophasic/iron days 25-28 | Ethinyl estradiol 20 mcg (days 1-24) | Norethindrone acetate 1 mg (days 1-24) | Oral | Avoid |
| Gildess Fe 1.5/30, Gildess Fe 1.5/30, Junel Fe 1.5/30, Loestrin Fe 1.5/30, Microgestin Fe 1.5/30 | Monophasic/iron days 22-28 | Ethinyl estradiol 30 mcg | Norethindrone acetate 1.5 mg | Oral | Avoid |
| Implanon | Progestin only | Etonogestrel 60-70 mcg/day (year 1), 35-45 mcg/day (year 2), 30-40 mcg/day (year 3) | Subdermal Implant | Acceptable | |
| Camrese Lo | Continuous cycle regimen | Ethinyl estradiol 20 mcg (days 1-84), 10 mcg (days 85-91) | Levonorgestrel 0.10 mg (days 1-84) | Oral | Avoid |
| Introvale, Jolessa, Quasense, Seasonale | Continuous cycle regimen | Ethinyl estradiol 30 mcg (days 1-84) | Levonorgestrel 0.15 mg (days 1-84) | Oral | Avoid |
| Camrese | Continuous cycle regimen | Ethinyl estradiol 30 mcg (days 1-84), 10 mcg (days 85-91) | Levonorgestrel 0.15 mg (days 1-84) | Oral | Avoid |
| Junel-21 1/20, Loestrin 21 1/20, Microgestin 1/20 | Monophasic | Ethinyl estradiol 20 mcg | Norethindrone acetate 1 mg | Oral | Avoid |
| Junel-21 1.5/30, Loestrin 21 1.5/30, Microgestin 1.5/30 | Monophasic | Ethinyl estradiol 30 mcg | Norethindrone acetate 1.5 mg | Oral | Avoid |
| Levlen, Levora, Nordette, Portia | Monophasic | Ethinyl estradiol 30 mcg | Levonorgestrel 0.15 mg | Oral | Avoid |
| Lo Loestrin Fe | Monophasic/iron days 26-28 | Ethinyl estradiol 10 mcg (days 1-26) | Norethindrone acetate 1 mg (days 1-24) | Oral | Avoid |
| LoSeasonique | Continuous cycle regimen | Ethinyl estradiol 20 mcg (days 1-84), 10 mcg (days 85-91) | Levonorgestrel 0.1 mg (days 1-84) | Oral | Avoid |
| Lybrel | Continuous | Ethinyl estradiol 20 mcg | Levonorgestrel 90 mcg | Oral | Avoid |
| Mirena | Progestin only | Levonorgestrel 20 mcg/day for 5 years | Intrauterine device ( | Acceptable | |
| MonoNessa, Ortho-Cyclen, Previfem, Sprintec | Monophasic | Ethinyl estradiol 35 mcg | Norgestimate 0.25 mg | Oral | Avoid |
| Natazia | Quadrephasic | Estradiol valerate 3 mg (days 1-2), 2 mg (days 3-24), 1 mg (days 25-26) | Dienogest none (days 1-2), 2 mg (days 3-7), 3 mg (days 8-24), none (days 25-28) | Oral | Avoid |
| Necon 1/35, Norinyl 1/35, Nortrel 1/35, Ortho-Novum1/35 | Monophasic | Ethinyl estradiol 35 mcg | Norethindrone 1 mg | Oral | Avoid |
| Necon 1/50, Norinyl 1/50, Ortho-Novum1/50 | Monophasic | Mestranol 50 mcg | Norethindrone 1 mg | Oral | Avoid |
| Necon 7/7/7, Nortrel 7/7/7, Ortho-Novum 7/7/7 | Triphasic | Ethinyl estradiol 35 mcg | Norethindrone 0.5 mg (days 1-7), 0.75 mg (days 8-14), 1 mg (days 15-21) | Oral | Avoid |
| Necon 10/11, Ortho-Novum10/11 | Biphasic | Ethinyl estradiol 35 mcg | Norethindrone 0.5mg (days 1-10), 1 mg (days 11-21) | Oral | Avoid |
| Next Choice, Next Step, Plan B | Emergencycontraception | Levonorgestrel 0.75 mg | Oral | Acceptable | |
| NuvaRing | Combination | Ethinyl estradiol 0.015 mg/day | Etonogestrel 0.12 mg/day | Vaginal ring | Avoid |
| Ocella, Syeda, Yasmin | Monophasic | Ethinyl estradiol 30 mcg | Drospirenone 3 mg | Oral | Avoid |
| Ogestrel | Monophasic | Ethinyl estradiol 50 mcg | Norgestrel 0.5 mg | Oral | Avoid |
| Low-Ogestrel | Monophasic | Ethinyl estradiol 30 mcg | Norgestrel 0.3 mg | Oral | Avoid |
| Ortho Evra | Combination | Ethinyl estradiol 20 mcg/day | Norelgestromin 150 mcg/day | Transdermalpatch | Avoid |
| Ortho-Tri-Cyclen, TriNessa, Tri-Previfem, Tri-Sprintec | Triphasic | Ethinyl estradiol 35 mcg | Norgestimate 0.18 mg (days 1-7), 0.215 mg (days 8-14), 0.25 mg (days 15-21) | Oral | Avoid |
| Ortho-Tri-Cyclen Lo, Tri-Lo-Sprintec | Triphasic | Ethinyl estradiol 25 mcg | Norgestimate 0.18 mg (days 1-7), 0.215 mg (days 8-14), 0.25 mg (days 15-21) | Oral | Avoid |
| Ovcon-50 | Monophasic | Ethinyl estradiol 50 mcg | Norethindrone 1 mg | Oral | Avoid |
| Ovrette | Progestin only | Norgestrel 0.075 mg | Oral | Acceptable | |
| ParaGard | Non-hormonal (copper) | Intrauterine device ( | Acceptable | ||
| Plan B One-Step | Emergency contraception | Levonorgestrel 1.5 mg | Oral | Acceptable | |
| Prefest | Multiphasic | Ethinyl estradiol 1mg (days 1-6) | Norgestimate 0.09 mg (days 4-6) | Oral | Avoid |
| Preven | Emergency contraception | Ethinyl estradiol 50 mcg | Levonorgestrel 0.25 mg | Oral | Avoid |
| Safyral | Monophasic + levomefolate calcium 0.451 mg days 22-28 | Ethinyl estradiol 30 mcg | Drospirenone 3 mg | Oral | Avoid |
| Seasonique | Continuous cycle regimen | Ethinyl estradiol 30 mcg (days 1-84), 10 mcg (days 85-91) | Levonorgestrel 0.15 mg (days 1-84) | Oral | Avoid |
| Tri-Norinyl | Triphasic | Ethinyl estradiol 35 mcg | Norethindrone 0.5 mg (days 1-7), 1 mg (days 8-16), 0.5 mg (days 17-21) | Oral | Avoid |
| Zovia 1/50 | Monophasic | Ethinyl estradiol 50 mcg | Ethynodiol diacetate 1 mg | Oral | Avoid |
| Zarah | Monophasic | Ethinyl estradiol 30 mcg | Drospirenone 3 mg | Oral | Avoid |
Foul-Tasting Drugs That Might Alter the Taste of Milk
| Common Foul-Tasting Drugs | Trade Names |
|---|---|
| Acyclovir | Aciclover, Acyclo-V, Aviraz, Lipsovir, Zovirax, Zyclir |
| Amlodipine | Istin, Norvasc |
| Azelastine | Astelin, Astepro, Azep, Optilast, Optivar, Rhinolast |
| Azithromycin | Zithromax |
| Captopril | Acepril, Capoten |
| Cetrizine | Zyrtec |
| Cholecalciferol | |
| Ciprofloxacin | Ciloxan, Cipro, Ciproxin |
| Clarithromycin | Biaxin, Klacid, Klaricid |
| Clindamycin | Cleocin, Clindacin |
| Clomipramine | Anafranil, Placil |
| Cod Liver Oil | |
| Desipramine | Norpramin, Pertofran |
| Dextromethorphan | Babee Cof Syrup, Creomulsion, Dexalone, Hold |
| Didanosine | Videx |
| Diethylpropion | Dospan, Tenuate, Tepanil |
| Diltiazem | Adizem, Britiazim, Cardcal, Cardizem, Cartia |
| Disulfiram | Antabuse |
| Donepezil | Aricept |
| Doxepin | Adapin, Deptran, Silenor, Sinequan |
| Doxycycline | Doryx, Doxychel, Doxycin, Doxylar, Doxylin, Periostat, Vibra-Tabs, Vibramycin |
| Efavirenz | Atripla, Sustiva |
| Emedastine | |
| Enalapril | Amprace, Innovace, Renitec, Vasotec |
| Enoxacin | Comprecin, Enoxin, Penetrex |
| Erythromycin | Ceplac, E-Mycin, |
| Famotidine | Pepcid, Pepcid |
| Flecainide | Tambocor |
| Hydrochlorothiazide | Direma, Diuchlor H, Esidrex, Esidrix, Hydrodiuril, Modizide, Oretic, Tekturna |
| Imipramine | Impril, Melipramine, Tofranil |
| Indinavir | Crixivan |
| Labetolol | Labrocol, Normodyne, Presolol, Trandate |
| Lamivudine | 3 |
| Metronidazole | Flagyl, Metrocream, Metrolotion, Metrozine, Neo-Metric |
| Mexiletene | Mexitil |
| Nedocromil | Tilade |
| Oxypentifylline | |
| Penicillins | |
| Phentermine | Adipex-P, Duromine, Fastin, Ionamin, Zantryl |
| Potassium Chloride | Micro-K, K-Dur, Slow-K |
| Potassium Iodide | |
| Prednisolone Powder | Prednisolone, Prednisone |
| Procainamide | Procan, Procan |
| Propafenone | Arythmol, Rythmol |
| Propranolol | Cardinol, Deralin, Inderal |
| Ritonavir | Norvir |
| Saquinanir | Fortovase |
| Stavudine | Zerit |
| Sulfamethoxazole + Trimethoprim | Bactrim, Cotrim, Resprim-Forte, Septra, Sulfatrim |
| Tinidazole | Fasigyne, Tindamax |
| Valacyclovir | Valtrex |
| Zidovudine | Combivir, Retrovir |
Foul-smelling/tasting drugs when introduced to an infant in breast milk, may cause alteration in the taste of breast milk and could possibly cause a “breastfeeding strike” in an infant.
Combination Drugs
| Trade Name | Drugs |
|---|---|
| Acanya | Benzoyl Peroxide, Clindamycin |
| Accuretic | Hydrochlorothiazide, Quinapril |
| Advair | Fluticasone, Salmeterol Xinafoate |
| Advair Diskus | Fluticasone, Salmeterol Xinafoate |
| Advair Diskus 100/50 | Fluticasone, Salmeterol Xinafoate |
| Advair Diskus 250/50 | Fluticasone, Salmeterol Xinafoate |
| Advair Diskus 500/50 | Fluticasone, Salmeterol Xinafoate |
| Advair | Fluticasone, Salmeterol Xinafoate |
| Advair Inhalation Aerosol | Fluticasone, Salmeterol Xinafoate |
| Altafluor | Benoxinate, Fluorescein |
| Anexsia | Hydrocodone, Acetaminophen |
| Articadent Dental With Epinephrine | Articaine, Epinephrine |
| Astracaine | Articaine, Epinephrine |
| Astracaine Dental With Epinephrine | Articaine, Epinephrine |
| Atripla | Emtricitabine, Tenofovir Disoproxil Fumarate |
| Azor | Amlodipine Besylate, Olmesartan, Medoxomil |
| Bancap | Acetaminophen, Butalbital, Caffeine |
| Benicar | Hydrochlorothiazide, Olmesartan, Medoxomil |
| Benzaclin | Benzoyl Peroxide, Clindamycin |
| Ceta Plus | Acetaminophen, Hydrocodone |
| Chlorax | Chlordiazepoxide, Clidinium Bromide |
| Clinoxide | Chlordiazepoxide, Clidinium Bromide |
| Combivent | Albuterol, Ipratropium Bromide |
| Duac | Benzoyl Peroxide, Clindamycin |
| Duac | Benzoyl Peroxide, Clindamycin |
| Dulera | Formoterol, Mometasone |
| DuoNeb | Albuterol, Ipratropium Bromide |
| Dyazide | Hydrochlorothiazide, Triamterene |
| Elavil Plus | Amitriptyline, Perphenazine |
| Endocet | Acetaminophen, Oxycodone |
| Endodan | Acetylsalicylic Acid, Oxycodone |
| Etrafon | Amitriptyline, Perphenazine |
| Etrafon 2-10 | Amitriptyline, Perphenazine |
| Etrafon A | Amitriptyline, Perphenazine |
| Entrafon | Amitriptyline, Perphenazine |
| Fioricet | Acetaminophen, Butalbital, Caffeine |
| Fiorinal | Acetylsalicylic Acid, Butalbital, Caffeine |
| Fiorinal Codeine | Butalbital, Caffeine, Codeine |
| Flurate | Benoxinate, Fluorescein |
| Fluress | Benoxinate, Fluorescein |
| Flurox | Benoxinate, Fluorescein |
| Glucovance | Glyburide, Metformin |
| Harvoni | Ledipasvir + Sofosbuvir |
| Hycodan | Homatropine, Hydrocodone |
| Hydrene | Hydrochlorothiazide, Triamterene |
| Hyzaar | Hydrochlorothiazide, Losartan |
| Janumet | Metformin, Sitagliptin Phosphate |
| Jentadueto | Linagliptin, Metformin |
| Librax | Chlordiazepoxide, Clidinium Br |
| Lorcet | Acetaminophen, Hydrocodone |
| Lortab | Acetaminophen, Hydrocodone |
| Lotrel | Amlodipine Besylate, Benazepril |
| Magnacet | Acetaminophen, Oxycodone |
| Malarone | Atovaquone, Proguanil |
| Maxidone | Acetaminophen, Hydrocodone |
| Maxzide | Hydrochlorothiazide, Triamterene |
| Metaglip | Glipizide, Metformin |
| Mutabon D | Amitriptyline, Perphenazine |
| Narvox | Acetaminophen, Oxycodone |
| Norco | Acetaminophen, Hydrocodone |
| Oxycocet | Acetaminophen, Oxycodone |
| Percocet | Acetaminophen, Oxycodone |
| Percodan | Acetylsalicylic Acid, Oxycodone |
| Perloxx | Acetaminophen, Oxycodone |
| Prevpac | Amoxicillin, Clarithromycin, Lansoprazole |
| Primalev | Acetaminophen, Oxycodone |
| Qsymia | Phentermine, Topiramate |
| Rebetron | Interferon Alfa-2B, Ribavirin |
| Roxicet | Acetaminophen, Oxycodone |
| Roxilox | Acetaminophen, Oxycodone |
| Septanest | Articaine, Epinephrine |
| Septocaine | Articaine, Epinephrine |
| Seretide | Fluticasone, Salmeterol Xinafoate |
| Symbicort | Budesonide, Formoterol |
| Tramacet | Acetaminophen, Tramadol |
| Treximet | Naproxen, Sumatriptan |
| Tri-Luma | Fluocinolone, Hydroquinone, Tretinoin |
| Triamco | Hydrochlorothiazide, Triamterene |
| Triamzide | Hydrochlorothiazide,Triamterene |
| Triavil | Amitriptyline, Perphenazine |
| Triazide | Hydrochlorothiazide, Triamterene |
| Tribenzor | Amlodipine Besylate, Hydrochlorothiazide, Olmesartan Medoxomil |
| Truvada | Emtricitabine, Tenofovir Disoproxil Fumarate |
| Two-Dyne | Acetaminophen, Butalbital, Caffeine |
| Tylox | Acetaminophen, Oxycodone |
| Ultracaine Ds | Articaine, Epinephrine |
| Ultracaine Ds Forte | Articaine, Epinephrine |
| Ultracet | Acetaminophen, Tramadol |
| Veltin | Clindamycin, Tretinoin |
| Vicodin | Acetaminophen, Hydrocodone |
| Vimovo | Esomeprazole, Naproxen |
| Ziac | Bisoprolol, Hydrochlorothiazide |
| Ziana | Clindamycin, Tretinoin |
| Zydone | Acetaminophen, Hydrocodone |
| Zylet | Loteprednol, Tobramycin |