Psychiatric Medications and Breastfeeding

Medications and Mothers' Milk
Thirteenth Edition
2008
Thomas W. Hale PhD

Dr. Hale's Lactation Risk Category:

L1 SAFEST:
Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable to the infant.

L2 SAFER:
Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects to the infant. And/or the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.

L3: MODERATELY SAFE:
There are no controlled studies in breastfeeding women, however, the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential health benefit justifies the potential risk to the infant. (New medications that have absolutely no published data are automatically categorized in this category, regardless of how safe they may be).

L4 POSSIBLY HAZARDOUS:
There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits from use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

L5 CONTRAINDICATED:
Studies in breastfeeding mothers have demonstrated that there is significant documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.



A

Abilify (Aripiprazole)-L3
Adapin (Doxepin Silenor Sinequan)-L5
Adderall (Dextroamphetamine and Amphetamine)-L3
Alprazolam(Niravam Xanax)-L3
Amantadine (Symadine Symmetrel)-L3
Ambien (Zolpidem Edluar Zolpimist)-L3
Amitripilene (Elavil Endep Vanatrip)-L3
Anafranil (Clomipramine) -L3
Anx (Atarax Atazine Hypam Rezine Hydroxyzine Vistaril)-L1
Aplenzin (Budeprion Buproban Bupropion Wellbutrin Zyban )-L3
Aripiprazole (Abilify)-L3
Atarax (Anx Atazine Hypam Rezine Hydroxyzine Vistaril)-L1
Atazine(Anx Atarax Hypam Rezine Hydroxyzine Vistaril)-L1
Ativan (Lorazepam)-L3


B

Budeprion (Aplenzin Buproban Bupropion Wellbutrin Zyban )-L3
Buproban (Aplenzin Budeprion Bupropion Wellbutrin Zyban )-L3
Bupropion (Aplenzin Budeprion BuprobanWellbutrin Zyban )-L3
Buspar (Vanspar Buspirone)-L3
Buspirone (Buspar Vanspar)-L3

C

Carbamazepine (Carbatrol Epitol Equetro Tegretol)-L2
Carbatrol (Carbamazepine Epitol Equetro Tegretol)-L2
Catapres (Clonidine Kapvay Nexiclon)-L3
Ceberclon (Clonazepam Klonopin Valpax)-L3
Celexa (Citalopram)-L2
Chantix (Varenicline)-L4
Chlorpromazine (Thorazine)-L3
Citalopram (Celexa)-L2
Clomipramine (Anafranil) -L3
Clonazepam(Ceberclon Klonopin Valpax)-L3
Clonidine (Catapres Kapvay Nexiclon)-L3
Clozapine(Clozaril Fazaclo)-L3
Clozaril (Clozapine Fazaclo)-L3
Concerta (Metadate Methylin Methylphenidate Ritalin)-L3
Cymbalta (Duloxetine)-L3
Cytomel (Liothyronine)-L2

D

Depakene (Depakote Epilim Stavzor Valproic Acid)-L3
Depakote (Depakene Epilim Stavzor Valproic Acid)-L3
Desyrel (Oleptro Trazadone)-L2
Dextroamphetamine and Amphetamine (Adderall )-L3
Doxepin (Adapin Silenor Sinequan)-L5
Duloxetine (Cymbalta)-L3



E

Edluar (Ambien Zolpidem Zolpimist)-L3
Effexor (Venlafaxine)-L3
Elavil (Amitripilene Endep Vanatrip)-L3
Emsam (Selegiline Transdermal)-L4
Endep (Elavil Amitripilene Vanatrip)-L3
Epilim (Depakene Depakote Stavzor Valproic Acid)-L3
Epitol (Carbatrol Carbamazepine Equetro Tegretol)-L2
Escitalopram (Lexapro)-L2
Eskalith (Lithobid Lithium )-L3
Equetro (Carbatrol Carbamazepine Epitol Tegretol)-L2
Eszopiclone (Lunestar Lunesta)-L3

F

Fanatrex (Gabarone Gralise Horizant Neurontin Gabapentin)-L2
Faverin (Fluvoxamine)-L2
Fazaclo (Clozapine Clozaril)-L3
Fluoxetine (Prozac Rapiflux Sarafem Selfemra)-L2
Fluoxetine and Olanzapine (Symbyax)-L2
Fluvoxamine (Faverin)-L2



G

Gabapentin (Fanatrex Gabarone Gralise Horizant Neurontin)-L2
Gabarone (Fanatrex Gabapentin Gralise Horizant Neurontin)-L2
Geodon (Ziprasidone)-L4
Gralise (Fanatrex Gabarone Gabapentin Horizant Neurontin)-L2

H

Horizant (Fanatrex Gabarone Gabapentin Gralise Neurontin)-L2
Hydroxyzine (Anx Atarax Rezine Atazine Hypam Vistaril)-L1
Hypam (Anx Atarax Rezine Atazine Hydroxyzine Vistaril)-L1
Hypericum perforatum L. (St. John's Wort)-L2

I

Inderal (InnoPran XL Propranolol)-L2
InnoPran XL(Inderal Propranolol)-L2

K

Kapvay (Catapres Clonidine Nexiclon)-L3
Klonopin (Clonazepam Ceberclon Valpax)-L3

L

Lamictal (Lamotrigine)-L3
Lamotrigine (Lamictal)-L3
Lexapro (Escitalopram)-L2
Liothyronine (Cytomel)-L2
Lithium (Eskalith Lithobid)-L3
Lithobid (Eskalith Lithium )-L3
Lorazepam (Ativan)-L3
Lunesta (Eszopiclone Lunestar)-L3
Lunestar (Eszopiclone Lunesta)-L3
Lyrica (Pregabalin)-L3



M

Manerix (Moclobemide)-L3
Mellaril (Thioridazine)-L4
Metadate (Concerta Methylin Methylphenidate Ritalin)-L3
Methylin (Concerta Metadate Methylphenidate Ritalin)-L3
Methylphenidate (Concerta Metadate Methylin Ritalin)-L3
Minipress (Prazosin)-L4

Mirapex (Pramipexole)-L4
Mirtazapine (Remeron)-L3
Moclobemide (Manerix)-L3

N

Neurontin (Fanatrex Gabarone Gralise Horizant Gabapentin)-L2
Nexiclon (Kapvay Catapres Clonidine)-L3
Niravam (Alprazolam Xanax)-L3

O

Oleptro (Desyrel Trazadone)-L2
Oxcarbazepine (Trileptal)-L3

P

Paroxetine (Paxil Pexeva)-L2
Paxil (Pexeva Paroxetine)-L2
Pexeva (Paxil Paroxetine)-L2
Pramipexole(Mirapex)-L4
Prazosin (Minipress)-L4
Pregabalin (Lyrica)-L3
Propranolol (Inderal InnoPran XL)-L2
Prozac (Rapiflux Sarafem Selfemra Fluoxetine)-L2

Q

Quetiapine (Seroquel)-L2

R

Rapiflux (Fluoxetine Prozac Sarafem Selfemra)-L2
Remeron (Mirtazapine)-L3
Rezine(Anx Atarax Atazine Hypam Hydroxyzine Vistaril)-L1
Risperdal (Risperidone)-L3
Risperidone (Risperdal)-L3
Ritalin (Concerta Metadate Methylin Methylphenidate)-L3



S

Sarafem (Fluoxetine Prozac Rapiflux Selfemra)-L2
Selegiline Transdermal (Emsam)-L4
Selfemra (Fluoxetine Prozac Rapiflux Sarafem)-L2
Seroquel (Quetiapine)-L2
Sertraline(Zoloft)-L2
Silenor (Adapin Doxepin Sinequan)-L5
Sinequan (Adapin Doxepin Silenor)-L5
St. John's Wort (Hypericum perforatum L.)-L2
Stavzor (Depakene Depakote Epilim Valproic Acid)-L3
Symadine (Amantadine Symmetrel)-L3
Symbyax (Fluoxetine and Olanzapine)-L2
Symmetrel (Symadine Amantadine)-L3



T

Tegretol (Carbatrol Epitol Equetro Carbamazepine)-L2
Thioridazine (Mellaril)-L4
Thorazine (Chlorpromazine)-L3
Topamax (Topiramate Topiragen)-L3
Topiragen (TopiramateTopamax)-L3
Topiramate (Topamax Topiragen)-L3
Trazadone (Desyrel Oleptro)-L2
Trileptal (Oxcarbazepine)-L3

V

Valpax (Ceberclon Clonazepam Klonopin)-L3
Valproic Acid (Depakene Depakote Epilim Stavzor)-L3
Vanatrip (Endep Elavil Amitripilene)-L3
Vanspar (Buspar Buspirone)-L3
Varenicline (Chantix)-L4
Venlafaxine (Effexor)-L3
Vistaril (Anx Atarax Atazine Hypam Rezine Hydroxyzine)-L1

W

Wellbutrin (Aplenzin Budeprion Buproban Bupropion Zyban )-L3

X

Xanax (Niravam Alprazolam)-L3

Z

Ziprasidone (Geodon)-L4
Zoloft (Sertraline)-L2
Zolpidem (Edluar Ambien Zolpimist)-L3
Zolpimist (Edluar Ambien Zolpidem)-L3
Zyban (Aplenzin Budeprion Buproban Bupropion Wellbutrin)-L3

***Meds in Bold are Brand names and Meds in Italic are the generic or chemical names.****

This is by no means an exhaustive list. Hope it helps someone!

Thanks for the list! I am currently breastfeeding my son (10 months)) and am taking seroquel at night for sleep. My pdoc said it is one of the safer and more commonly drugs used while breastfeeding. I feel a little better about it, although I still am not that happy about taking meds while nursing, I am always worrying about my little guy.

i took paroxetine when i was breastfeeding - seemed one of the safest to take. i bf my daughter til she was 18 months old and she is nearly 4 now and fine and healthy

Are there any that are safe while pregnant?

Did you take it while you were pregnant?

Nobody REALLY knows what is "safe." Human studies are not ethical and cannot be done!

Pregnancy is a whole other ball game. That is a yes and no question. There are some drugs considered "safe" but the reality is we just don't know enough yet. Researchers have to look at women who use(d) the meds during pregnancy and record outcomes. It takes a long time and it is a scary game.

I am 27 and hope I can have a baby someday despite my bipolar. I am scared to get pregnant though for fear it will worsen my illness. If I ever get pregnant or breastfeed I will be sure to find the safest drug to be one for my baby.

I heard it was not a good AD 2 take while breastfeeding. I actually quit breastfeeding at 3 months to go back on it. I'm glad it went well for you, but it's actually on those tv lawsuit commercials for causing heart defects in babies.

thank you for this list! fwiw i took zoloft through 2nd pregnancy and while breastfeeding. now i am on luvox & hydroxyzine and still nursing 19 mo old. so far so good.

You are welcome, glad it helped

Thank you so much for this list! I'm currently breastfeeding my 15mo.