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Home , Ammonium chloride, Calcium dobesilate, Clomifene, Iobitridol, Policresulen, Pregnancy category

Department of Pharmaceutical Care

Drug Use in & Lactation

 The following tables summarize safety of drug use in pregnancy and lactation.  of herbal origin are excluded from the list.  Under the column "Drug-Pregnancy Categories", letters A, B, C, D, and X signify the FDA Pregnancy categories.  These five categories indicate the potential of a systemically-absorbed drug to cause birth defects; the key differentiation among the categories rests upon the reliability of documentation and the risk: benefit ratio.

FDA Pregnancy Categories:

A : Controlled studies in pregnant women fail to demonstrate a risk to the fetus in the first trimester with no evidence of risk in later trimesters. The possibility of fetal harm appears remote.

B : Either animal-reproductive studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women, or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester and there is no evidence of risk in later trimesters.

C : Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal effects or other) and there are no controlled studies in women, or studies in women and animals are not available. Drugs should be given only if the potential benefits justify the potential risk to the fetus.

D : There is positive evidence of human fetal risk, but the benefit from use in pregnant women may be acceptable despite the risk (If the drug is needed for life threatening situations or for serious diseases for which safer drugs can not be used or are ineffective).

X : Studies in animals or human beings have demonstrated fetal abnormalities or there is evidence of fetal risk based on human experience, or both, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated in women who are or may become pregnant.

Pharmacy & Therapeutic Committee- Sep 2018 Page 1 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

 For drugs not FDA approved; other classification systems were used to identify the pregnancy categories, whenever possible, the two other systems used are:

1. Micromedex Pregnancy Ratings:

Fetal risk cannot be Available evidence is inconclusive or is inadequate for determining ruled out fetal risk when used in pregnant women or women of childbearing potential. Weigh the potential benefits of drug treatment against potential risks before prescribing this drug during pregnancy.

Fetal risk has been Evidence has demonstrated fetal abnormalities or risks when used demonstrated during pregnancy or in women of childbearing potential. An alternative to this drug should be prescribed during pregnancy or in women of childbearing potential.

Fetal risk is minimal The weight of an adequate body of evidence suggests this drug poses minimal risk when used in pregnant women or women of childbearing potential.

2. Australian Drug Evaluation Committee (ADEC) Pregnancy Category Definitions

A : Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed.

B1 : Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have not shown evidence of an increased occurrence of fetal damage.

B2 : Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals are inadequate or may be lacking, but available data show no evidence of an increased occurrence of fetal damage.

B3 : Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have shown evidence of an increased occurrence of fetal damage, the

Pharmacy & Therapeutic Committee- Sep 2018 Page 2 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

significance of which is considered uncertain in humans.

C : Drugs which, owing to their pharmacological effects, have caused or may be suspected of causing harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details.

D : Drugs which have caused, are suspected to have caused, or may be expected to cause an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details.

X : Drugs that have such a high risk of causing permanent damage to the fetus that they should not be used in pregnancy or when there is a possibility of pregnancy.

 Note: For drugs in the B1, B2 and B3 categories, human data are lacking or inadequate and sub- categorization is therefore based on available animal data. The allocation of a B category does not imply greater safety than the C category. Drugs in category D are not absolutely contraindicated in pregnancy (e.g. anticonvulsants). Moreover, in some cases the 'D' category has been assigned on the basis of 'suspicion'.  If there was no data under the previous three categorizations, the drug-pregnancy category is assigned as "N/A"  Data for use during feeding, are complied from FDA data, WHO data and Micromedex Lactation Ratings:

1. WHO Lactation Ratings:  Avoid breastfeeding  Avoid breastfeeding if possible. May inhibit lactation  Avoid breastfeeding if possible. Monitor infant for side effects  Compatible with breastfeeding  Compatible with breastfeeding. Monitor infant for side effects  WHO documentation states insufficient data

2. Micromedex Lactation Ratings:

Infant risk cannot be Available evidence is inconclusive or is inadequate for determining ruled out fetal risk when used in pregnant women or women of childbearing potential. Weigh the potential benefits of drug treatment against potential risks before prescribing this drug during breastfeeding

Pharmacy & Therapeutic Committee- Sep 2018 Page 3 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Infant risk has been Evidence and/or expert consensus has demonstrated harmful demonstrated infant effects when used during breastfeeding. An alternative to this drug should be prescribed or patients should be advised to discontinue breastfeeding.

Infant risk is minimal The weight of an adequate body of evidence and/or expert consensus suggests this drug poses minimal risk to the infant when used during breastfeeding

Milk effects are Evidence suggests this drug may alter milk production or possible composition. If an alternative to this drug is not prescribed, monitor the infant for adverse effects and/or adequate milk intake

 Abbreviations used in the tables:

AAP: American Academy of Pediatrics

APR: Australian Pregnancy Ratings

FDA: U.S. Food and Drug Administration

IU: International Unit

N/A: no data available

MLR: Micromedex Lactation Ratings

MPR: Micromedex Pregnancy Ratings

RDA: Recommended daily allowance

WHO: World Health Organization

Pharmacy & Therapeutic Committee- Sep 2018 Page 4 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations in breast milk unknown/not Abatacept C recommended (Possible toxicity) Abiraterone X Not indicated for use in women Excretion in breast milk unknown/not Acarbose B recommended Acetaminophen [] C Excreted in breast milk/use caution Acetaminophen [Paracetamol] Refer to Individual Refer to Individual Agents and Codeine Agents Acetaminophen [Paracetamol] C Excreted in breast milk/not recommended and Codeine and Caffeine Acetaminophen [Paracetamol] C Excreted in breast milk/not recommended and Tramadol Acetazolamide C Excreted in breast milk/not recommended Excretion in breast milk unknown/use Acetic C caution Excretion in breast milk unknown/use Acetylcysteine B caution Aciclovir [Acyclovir] (Systemic, B Excreted in breast milk/use caution Topical) MPR: Fetal risk Excretion in breast milk unknown/use Activated Charcoal cannot be ruled out caution Adalimumab B Excreted in breast milk/use caution Excretion in breast milk unknown/use Adapalene C caution Excretion in breast milk unknown/not Adefovir C recommended Excretion in breast milk unknown/not Adenosine C recommended Excretion in breast milk unknown/not Ado-Trastuzumab D recommended Aescin No data available No data available Excretion in breast milk unknown/not Aflibercept C recommended Agomelatine (P) ADEC*: B1 MLR: Infant risk cannot be ruled out C Excreted in breast milk/use caution Albumin C MLR: Infant risk cannot be ruled out Excretion in breast milk unknown/use Alendronate C caution Alfacalcidol No data available Excreted in breast milk/not recommended

Pharmacy & Therapeutic Committee- Sep 2018 Page 5 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Alfuzosin B Excretion in breast milk unknown Alirocumab No data available Excreted in breast milk/not recommended Allopurinol C Excreted in breast milk/use caution Alpha-Lipoic Acid No data available Excretion in breast milk unknown ALPRAZolam (C) D Excreted in breast milk/not recommended Alprostadil C (Muse) Not intended for use by lactating women Excretion in breast milk unknown/use Alteplase C caution Aluminum Hydroxide B MLR: Infant risk cannot be ruled out Amantadine C Excreted in breast milk/not recommended Ambroxol No data available Excreted in breast milk/not recommended Excretion in breast milk unknown/use Amethocaine () C caution Amidotrizoate [] Briggs: No human data; probably C Meglumine [P] compatible Amikacin D Excreted in breast milk/not recommended Amiloride B Excreted in breast milk/contraindicated Excretion in breast milk unknown/use Amino C caution Aminophylline C Excreted in breast milk/not recommended Amiodarone D Excreted in breast milk/not recommended Amitriptyline C Excreted in breast milk/not recommended Excretion in breast milk unknown/not Amlodipine C recommended Excretion in breast milk Amlodipine and Atorvastatin X unknown/contraindicated Excretion in breast milk unknown/not Amlodipine and Olmesartan D recommended Excretion in breast milk unknown/not Amlodipine and Valsartan D recommended Amlodipine, Valsartan and Refer to Individual Refer to Individual Agents Hydrochlorothiazide Agents Briggs: No human data; probably C compatible B Excreted in breast milk/use caution Amoxicillin and Clavulanic Acid B Excreted in breast milk/use caution Excretion in breast milk unknown/not Amphotericin-B B recommended

Pharmacy & Therapeutic Committee- Sep 2018 Page 6 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations B Excreted in breast milk/use caution Ampicillin and Sulbactam B Excreted in breast milk/use caution Excretion in breast milk unknown/not X recommended Excretion in breast milk unknown/use Anidulafungin B caution Antihemophilic Factor (Human, Excretion in breast milk unknown/use C Recombinant) caution Excretion in breast milk unknown/not Apixaban B recommended Excretion in breast milk unknown/not Apomorphine C recommended ARIPiprazole (P) C Excreted in breast milk/not recommended Ascorbic Acid () C Excreted in breast milk/use caution (Acetylsalicylic Acid) D Excreted in breast milk/use caution Atenolol D Excreted in breast milk/use caution Atenolol and Chlortalidone Excretion in breast milk unknown/use D [Chlorthalidone] caution Excretion in breast milk unknown/use Atomoxetine C caution Excretion in breast milk AtorvaSTATin X unknown/contraindicated Atosiban No data available Excreted in breast milk/contraindicated Atropine B/C (Product Specific) Excreted in breast milk/use caution Excretion in breast milk unknown/not Axitinib D recommended Excretion in breast milk AzaCITIDine (P) D unknown/contraindicated AzaTHIOprine D Excreted in breast milk/not recommended Excretion in breast milk unknown/use Azelaic Acid B caution Excretion in breast milk unknown/use Azelastine C caution Excretion in breast milk unknown/use Azithromycin (Ophthalmic) B caution Azithromycin (Systemic) B Excreted in breast milk/use caution Bacitracin and Neomycin Refer to Individual Agents Refer to Individual Agents C Baclofen Excreted in breast milk/not recommended

Pharmacy & Therapeutic Committee- Sep 2018 Page 7 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations MLR: Infant risk is minimal (Not absorbed Sulfate (P) MPR: Fetal risk is minimal systemically) Excretion in breast milk unknown/not BCG C recommended Excretion in breast milk unknown/use Beclomethasone C caution Excretion in breast milk unknown/not Bemiparin No data available recommended Excretion in breast milk unknown/not Bendamustine D recommended Benoxinate (Oxybuprocaine) C Excreted in breast milk/use caution Excretion in breast milk unknown/use and Phenazone C caution Excretion in breast milk unknown/use Benzoyl Peroxide C caution Benzylpenicillin [Penicillin G] B Excreted in breast milk/use caution (Parenteral/Aqueous) Benzylpenicillin [Penicillin G] B Excreted in breast milk/use caution Benzathine Excretion in breast milk unknown/use Betahistine ADEC*: B2 caution Excretion in breast milk unknown/use (Systemic) C caution Excretion in breast milk unknown/use Betamethasone (Topical) C caution Betamethasone and Refer to Individual Refer to Individual Agents (Topical) Agents Excretion in breast milk unknown/not Bevacizumab C recommended Excretion in breast milk X unknown/contraindicated Excretion in breast milk unknown/use Bimatoprost C caution Bisacodyl ADEC*: A MLR: Infant risk cannot be ruled out Excretion in breast milk unknown/use Bisoprolol C caution Bisoprolol and Refer to Individual Refer to Individual Agents Hydrochlorothiazide Agents Excretion in breast milk unknown/use Bivalirudin B caution

Pharmacy & Therapeutic Committee- Sep 2018 Page 8 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Excretion in breast milk unknown/not Bleomycin D recommended Bosentan Contraindicated Not recommended Excretion in breast milk unknown/not Brimonidine B recommended Refer to Individual Brimonidine and Timolol Refer to Individual Agents Agents Excretion in breast milk unknown/not Bromazepam (C) ADEC*: C recommended Bromhexine ADEC*: A Excreted in breast milk/not recommended C (Capsule, Tablet)/B Excreted in breast milk/use caution Budesonide (Nasal, Oral (capsule, oral inhalation, tablet) Inhalation) Budesonide (Topical) C Excreted in breast milk/use caution Refer to Individual Budesonide and Formoterol Refer to Individual Agents Agents Excretion in breast milk unknown/not Bumetanide C recommended Bupivacaine C Excreted in breast milk/not recommended Bupreborphine

BuPROPion C Excreted in breast milk/use caution Excretion in breast milk unknown/not Cabergoline B recommended Excretion in breast milk unknown/not Cabozantinib D recommended Calcipotriol [Calcipotriene] and C Do not apply to the breast if breast-feeding Betamethasone Excretion in breast milk unknown/use Calcitonin C caution Calcium Acetate, Carbonate, MPR: Fetal risk MLR: Infant risk cannot be ruled out Chloride, Citrate, Gluconate cannot be ruled out No data available No data available Calcium Hydroxylapatite No data available No data available Excretion in breast milk unknown/use Calcium Polystyrene Sulphonate C caution Canagliflozin C Excreted in breast milk/use caution Excretion in breast milk unknown/not Candesartan D recommended

Pharmacy & Therapeutic Committee- Sep 2018 Page 9 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Candesartan and Refer to Individual Refer to Individual Agents Hydrochlorothiazide Agents Excretion in breast milk unknown/not Capecitabine D recommended Captopril D Excreted in breast milk/not recommended Excretion in breast milk unknown/use Carbachol C caution CarBAMazepine D Excreted in breast milk/not recommended Use in pregnancy prior to delivery is contraindicated. Carbetocin induced contractions are of a longer duration than those observed with oxytocin and are not stopped by Carbetocin discontinuation of Excreted in breast milk/use caution therapy. Improper use during pregnancy may produce symptoms similar to those observed with oxytocin overdosage (eg, hyperstimulation of , uterine rupture). Carbidopa and Levodopa C WHO: Avoid breastfeeding Carbimazole ADEC*: C AAP: Compatible with breastfeeding Excretion in breast milk unknown/not Carbocisteine [Carbocysteine] No data available recommended Excretion in breast milk unknown/not CARBOplatin D recommended Carboprost Trometamol C Excretion in breast milk unknown [Tromethamine] Excretion in breast milk unknown/not Carvedilol C recommended Excretion in breast milk unknown/use Caspofungin C caution [Cephalexin] B Excreted in breast milk/use caution

Pharmacy & Therapeutic Committee- Sep 2018 Page 10 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations CeFAZolin B Excreted in breast milk/use caution Cefdinir B Excretion in breast milk unknown Cefepime B Excreted in breast milk/use caution Cefixime B Excretion in breast milk unknown Cefprozil B Excreted in breast milk/use caution Ceftazidime B Excreted in breast milk/use caution Ceftriaxone B Excreted in breast milk/use caution Cefuroxime B Excreted in breast milk/use caution C (Prior to 30 weeks Celecoxib gestation)/D (≥30 Excreted in breast milk/use caution weeks gestation) Cephalexin B Excreted in breast milk/use caution Certolizumab Use with caution Not excreted in breast milk/use caution Cetirizine B MLR: Infant risk cannot be ruled out Excretion in breast milk X unknown/contraindicated Excretion in breast milk unknown/not Cetuximab C recommended Chloral Hydrate No data available Excreted in breast milk/not recommended Excretion in breast milk unknown/not Chlorambucil D recommended Excretion in breast milk unknown/use Gluconate B/C (Product Specific) caution Chloroquine C Excreted in breast milk/not recommended Chlorphenamine C WHO: Avoid breastfeeding [Chlorpheniramine] ADEC*: C Excreted in breast milk/not recommended MPR: Fetal risk Chlorzoxazone and Paracetamol MLR: Infant risk cannot be ruled out cannot be ruled out Chorionic (Human, Excretion in breast milk unknown/use X Recombinant) caution Excretion in breast milk unknown/use Ciclesonide C caution CicloSPORINE [CycloSPORINE] C Excreted in breast milk/not recommended (Systemic) Excretion in breast milk unknown/not Cinacalcet C recommended Excretion in breast milk unknown/not Cinnarizine No data available recommended

Pharmacy & Therapeutic Committee- Sep 2018 Page 11 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Excretion in breast milk unknown/use (Ophthalmic) C caution Ciprofloxacin (Systemic) C Excreted in breast milk/not recommended Excretion in breast milk unknown/use Cisatracurium B caution Cisplatin D Excreted in breast milk/not recommended Excreted in breast milk/consider Citalopram C risk:benefit Excretion in breast milk unknown/use Clarithromycin C caution (Systemic, topical) B Excreted in breast milk/not recommended Contraindicated in Clobazam the first trimester of Present in breast milk pregnancy Excretion in breast milk unknown/use Clomifene [ClomiPHENE] X caution ClomiPRAMINE C Excreted in breast milk/not recommended ClonazePAM D Excreted in breast milk/not recommended C Excreted in breast milk/use caution Excretion in breast milk unknown/not Clopidogrel B recommended Clotrimazole C Excretion in breast milk unknown Cloxacillin B WHO: Compatible with breastfeeding Colchicine C Excreted in breast milk/use caution MPR: Fetal risk Colecalciferol [Cholecalciferol] Excreted in breast milk/use caution cannot be ruled out Colestyramine [Cholestyramine] C Not excreted in breast milk/use caution Resin Colistimethate C Excreted in breast milk/use caution Excretion in breast milk unknown/use Cosyntropin C caution Co-Trimoxazole [Sulfamethoxazole D Excreted in breast milk/use caution and Trimethoprim] Crotamiton C Excretion in breast milk unknown Cyanocobalamin (Vitamin B12) C Excreted in breast milk/compatible Excretion in breast milk unknown/use Cyclobenzaprine B caution Excretion in breast milk unknown/use Cyclopentolate C caution

Pharmacy & Therapeutic Committee- Sep 2018 Page 12 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations D Excreted in breast milk/not recommended Cyproterone ADEC*: B3 Not intended for use by lactating women Cyproterone and X Excreted in breast milk/not recommended [Ethinyl ] Excretion in breast milk unknown/not Cytarabin D recommended

Excretion in breast milk unknown/ Decision Dapagliflozon C shall be made either to discontinue breastfeeding or to discontinue the drug Excretion in breast milk unknown/not Dabigatran C recommended

not indicated for use not indicated for use in women in women

Excretion in breast milk unknown/not Dacarbazine C recommended Excretion in breast milk unknown/not DACTINomycin D recommended Excretion in breast milk unknown/not Dalfampridine C recommended Dantrolene C Excreted in breast milk/not recommended Excretion in breast milk unknown/use Darbepoetin Alfa C caution Excretion in breast milk unknown/not Deferasirox C recommended Excretion in breast milk unknown/not X recommended Excretion in breast milk unknown/not Denosumab D (Xgeva®), X (Prolia®) recommended Desferrioxamine [Deferoxamine] C Excretion in breast milk unknown/use caution Excretion in breast milk unknown/use Desflurane B caution Desloratadine C Excreted in breast milk/not recommended Excretion in breast milk unknown/use Desmopressin B caution Desogestrel No data available Excreted in breast milk/use caution Desvenlafaxine C Excreted in breast milk/not recommended Excretion in breast milk unknown/use (Ophthalmic) C caution

Pharmacy & Therapeutic Committee- Sep 2018 Page 13 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Excretion in breast milk unknown/not Dexamethasone (Systemic) C recommended Excretion in breast milk unknown/not Dexlanzoprazole No data available recommended Excretion in breast milk unknown/use Dexmedetomidine C caution Excretion in breast milk unknown/use Dexpanthenol C caution Dextromethorphan ADEC*: A MLR: Infant risk is minimal Dextrose C (Injection, Infusion) MLR: Infant risk cannot be ruled out Dextrose and C Refer to Individual Agents Diazepam (C) D Excreted in breast milk/not recommended (Ophthalmic) C No data available C/D ≥30 weeks Diclofenac (Systemic) Excreted in breast milk/not recommended gestation (Oral) B (Topical Gel 3%) / C (Topical Gel 1%, Topical Solution, Excretion in breast milk unknown/not Diclofenac (Topical) Topical patch) / D recommended (Topical Patch and Solution ≥30 weeks' gestation) Excretion in breast milk No data available unknown/contraindicated Digoxin C Excreted in breast milk/use caution Excretion in breast milk unknown/use Digoxin Immune Fab C caution Dihydroergotamine X Excreted in breast milk/contraindicated Diloxanide Furoate Not recommended No data available Diltiazem C Excreted in breast milk/not recommended DimenhyDRINATE B Excreted in breast milk/not recommended Dimethindene No data available No data available Excretion in breast milk unknown/use Dimethyl Furmarate C caution Dinoprostone C Excretion in breast milk unknown (Systemic) B Excreted in breast milk/contraindicated Diphtheria, Pertussis, Tetanus Excretion in breast milk unknown/use B/C (Product Specific) Vaccine caution

Pharmacy & Therapeutic Committee- Sep 2018 Page 14 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Dipyridamole B Excreted in breast milk/use caution Excretion in breast milk unknown/use Dobutamine B caution Excretion in breast milk unknown/not DOCEtaxel D recommended Docusate ADEC*: A Excretion in breast milk unknown ADEC*: B2 Excreted in breast milk/not recommended Donepezil C Excretion in breast milk unknown/use caution Excretion in breast milk unknown/use DOPamine C caution Dornase alpha B Infant risk cannot be ruled out Excretion in breast milk unknown/not Dorzolamide C recommended Refer to Individual Dorzolamide and Timolol Refer to Individual Agents Agents Doxazosin C Excreted in breast milk/use caution DOXOrubicin (Conventional) D Excreted in breast milk/not recommended Excretion in breast milk unknown/not DOXOrubicin (Liposomal) No data available recommended D Excreted in breast milk/not recommended Excretion in breast milk unknown/not Dulaglutide Not recommended recommended Duloxetine C Excreted in breast milk/use caution Excretion in breast milk X unknown/contraindicated Excretion in breast milk unknown/not Dydrogesterone No data available recommended Excretion in breast milk unknown/use C caution Eletriptan C Excreted in breast milk/use caution Excretion in breast milk unknown/ Decision Empagliflozon C shall be made either to discontinue breastfeeding or to discontinue the drug Enalapril D Excreted in breast milk/not recommended Refer to Individual Enalapril and Hydrochlorothiazide Refer to Individual Agents Agents Excretion in breast milk unknown/not Enoxaparin B recommended Excretion in breast milk unknown/not Entecavir (P) C recommended

Pharmacy & Therapeutic Committee- Sep 2018 Page 15 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Excretion in breast milk unknown/use Epinastine C caution EPINEPHrine (Systemic, Oral Excretion in breast milk unknown/use C Inhalation) caution Excretion in breast milk unknown/not Epirubicin D recommended

Excretion in breast milk unknown/not Eprosartan D recommended Eprosartan/Hydrochlorothiazide D Excreted in breast milk/not recommended Eptacog Alfa Factor VIIa Excretion in breast milk unknown/not C (Recombinant) recommended Excretion in breast milk unknown/not Eribulin D recommended Excretion in breast milk unknown/not ERLOtinib D recommended Ertapenem B Excreted in breast milk/use caution Excretion in breast milk unknown/use Erythromycin (Ophthalmic) B caution Erythromycin (Systemic) B Excreted in breast milk/use caution Excretion in breast milk unknown/use Erythropoietin /Epoetin Alpha C caution Excreted in breast milk/consider risk: Escitalopram C benefit Excretion in breast milk unknown/not Esmolol C recommended Esomeprazole C Excreted in breast milk/use caution Estradiol (Systemic) X Excreted in breast milk/use caution Estradiol (Systemic) No data available Excreted in breast milk/use caution Etanercept B Excreted in breast milk/use caution Ethambutol C Excreted in breast milk/use caution Ethamsylate No data available No data available Ethinylestradiol [Ethinyl X Excreted in breast milk/not recommended Estradiol] and Desogestrel Ethinylestradiol [Ethinyl X Excreted in breast milk/not recommended Estradiol] and Ethinylestradiol [Ethinyl Estradiol] and Etonogestrel X Excreted in breast milk/not recommended

Pharmacy & Therapeutic Committee- Sep 2018 Page 16 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Ethinylestradiol [Ethinyl X Excreted in breast milk/not recommended Estradiol] and Norelgestromin Excretion in breast milk unknown/use Etomidate C caution MPR: Fetal risk Etonogestrel Excreted in breast milk/use caution cannot be ruled out Excretion in breast milk unknown/not Etoposide D recommended C (Prior to 30 weeks Excretion in breast milk Etoricoxib gestation)/D (≥30 unknown/contraindicated weeks gestation) D (Afinitor®)/C Excretion in breast milk unknown/not Everolimus (Zortress®) recommended Evolocumab No data available Excreted in breast milk/not recommended Excretion in breast milk unknown/not X recommended Excretion in breast milk unknown/use Exenatide (P) C caution Excretion in breast milk unknown/not Ezetimibe C recommended Ezetimibe and Simvastatin Refer to Individual Agents Refer to Individual Agents Factor IX (Human) C No data available Excretion in breast milk unknown/not Famciclovir B recommended Excretion in breast milk unknown/not Fampridine C recommended Fat Emulsion (Plant Based) C Excreted in breast milk/use caution Excretion in breast milk unknown/use Febuxostat C caution Excretion in breast milk unknown/not Felodipine C recommended Excretion in breast milk Fenofibrate and Derivatives C unknown/contraindicated FentaNYL (N) C Excreted in breast milk/not recommended Ferric Carboxymaltose C Excreted in breast milk/use caution Ferrous Sulfate B WHO: Compatible with breastfeeding Excretion in breast milk unknown/use Fexofenadine C caution Excretion in breast milk unknown/use Filgrastim C caution

Pharmacy & Therapeutic Committee- Sep 2018 Page 17 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Excretion in breast milk X unknown/contraindicated Excretion in breast milk unknown/not Fingolimod C recommended C (Single dose for Excreted in breast milk/use caution Fluconazole vaginal candidiasis)/

D Excretion in breast milk unknown/not Fludarabine D recommended Excretion in breast milk unknown/use Fludrocortisone C caution Excretion in breast milk unknown/use Flumazenil C caution MPR: Fetal risk Excretion in breast milk unknown/not Flunarizine cannot be ruled out recommended Fluorescein C Excreted in breast milk/use caution Excretion in breast milk FluoroURACIL (P) D unknown/contraindicated C Excreted in breast milk/not recommended B Not intended for use by lactating women Excretion in breast milk unknown/use Fluticasone (Nasal) C caution Excretion in breast milk unknown/use Fluticasone (Oral Inhalation) C caution Excretion in breast milk unknown/use Fluticasone and Salmeterol C caution Fluticasone and Formetrol Avoid unless benefit Not recommended outweigh risk Excretion in breast milk Fluvastatin X unknown/contraindicated Excreted in breast milk/consider risk: FluvoxaMINE C benefit Folic Acid A Excreted in breast milk/compatible Excretion in breast milk unknown/not Follitropin (Alfa & Beta) X recommended Excretion in breast milk unknown/use Fondaparinux B caution Fosfomycin B Excreted in breast milk/not recommended Fosinopril D Excreted in breast milk/not recommended

Pharmacy & Therapeutic Committee- Sep 2018 Page 18 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Excretion in breast milk unknown/not D recommended Furosemide C Excreted in breast milk/use caution Fusidic Acid (Ophthalmic & MPR: Fetal risk Excreted in breast milk/use caution Topical) cannot be ruled out Refer to Individual Fusidic Acid and Hydrocortisone Refer to Individual Agents Agents Gabapentin C Excreted in breast milk/use caution Excretion in breast milk unknown/use C caution Gadoterate Meglumine C Excretion in breast milk unknown/use caution Excretion in breast milk unknown/not Galantamine C recommended Excretion in breast milk unknown/use Ganciclovir (Ophthalmic) C caution Excretion in breast milk unknown/not Ganciclovir (Systemic) C recommended Excretion in breast milk unknown/use Gatifloxacin (Systemic) C caution Excretion in breast milk unknown/not GEMcitabine D recommended Excretion in breast milk unknown/not Gemfibrozil C recommended (Systemic) D Excreted in breast milk/use caution Glibenclamide [GlyBURIDE] B/C (Product Specific) Not recommended Glibenclamide [GlyBURIDE] and Refer to Individual Refer to Individual Agents Agents Excretion in breast milk Gliclazide ADEC*: C unknown/contraindicated Excretion in breast milk unknown/not Glimepiride C recommended Excretion in breast milk unknown/use Glucagon B caution [Glycerin] C MLR: Infant risk cannot be ruled out Excretion in breast milk unknown/use B (Injection)/C (Oral Glycopyrrolate caution Solution)

Excretion in breast milk unknown/not Golimumab B recommended

Pharmacy & Therapeutic Committee- Sep 2018 Page 19 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations X (Endometriosis, Endometrial Excretion in breast milk unknown/not Thinning); D recommended (Advanced ) Excretion in breast milk unknown/use Granisetron B caution GuaiFENesin C Excretion in breast milk unknown GuaiFENesin and Refer to Individual Refer to Individual Agents Dextromethorphan Agents Refer to Individual Agents GuaiFENesin, Dextromethorphan, Refer to Individual

and Phenylephrine Agents

GuaiFENesin, Pseudoephedrine, Refer to Individual Refer to Individual Agents and Dextromethorphan Agents C Excreted in breast milk/not recommended C Not excreted in breast milk/use caution A and Hepatitis B Excretion in breast milk unknown/use C Recombinant Vaccine caution Excretion in breast milk unknown/use Hepatitis A vaccine C caution Hepatitis B Immune Globulin Excretion in breast milk unknown/use C (Human) caution Hepatitis B Vaccine Excretion in breast milk unknown/use C (Recombinant) caution Human Chorionic Gonadotropin X MLR: Infant risk cannot be ruled out MPR: Fetal risk Excretion in breast milk unknown/not Hyaluronate and Derivatives cannot be ruled out recommended Excretion in breast milk unknown/use Hyaluronidase C caution HydrALAZINE C Excreted in breast milk/use caution Hydrochlorothiazide B Excreted in breast milk/not recommended Hydrochlorothiazide and Refer to Individual Refer to Individual Agents Agents Hydrocortisone (Systemic & C Excreted in breast milk/use caution Topical) Hydrocortisone, Hydroquinone, Excretion in breast milk unknown/use C and Tretinoin caution HYDROmorphone (N) C Excreted in breast milk/not recommended

Pharmacy & Therapeutic Committee- Sep 2018 Page 20 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Hydroquinone C Excretion in breast milk unknown/use caution Hydroxycarbamide D Excreted in breast milk/not recommended [Hydroxyurea] Hydroxychloroquine ADEC*: D Excreted in breast milk/not recommended Excretion in breast milk unknown/not Hydroxyprogesterone B recommended Hyoscine Butylbromide C Excreted in breast milk/use caution [Scopolamine] (Systemic) Excretion in breast milk unknown/use Ibandronic Acid [Ibandronate] C caution C/D ≥30 weeks Ibuprofen Excreted in breast milk/not recommended gestation Ifosfamide D Excreted in breast milk/not recommended Imatinib D Excreted in breast milk/not recommended Imipenem and Cilastatin C Excreted in breast milk/use caution Excretion in breast milk unknown/use Imiquimod C caution Excretion in breast milk unknown/use Immune Globulin C caution Excretion in breast milk unknown/not Indapamide B recommended Indacaterol maleate / Excretion in breast milk unknown/use C Glycopyrronium bromide caution C (<30 weeks gestation); C/D (≥30 Indometacin [Indomethacin] weeks gestation Excreted in breast milk/not recommended [manufacturer specific]) Excretion in breast milk unknown/not InFLIXimab B recommended Influenza Virus Vaccine Excretion in breast milk unknown/use B/C (Product Specific) (Inactivated) caution Insulin Aspart B Briggs: Compatible with breastfeeding Insulin Aspart Protamine and B Briggs: Compatible with breastfeeding Insulin Aspart Insulin Detemir B Briggs: Compatible with breastfeeding Insulin Degludec C Briggs: Compatible with breastfeeding Insulin Glargine C Briggs: Compatible with breastfeeding Insulin Glulisine C Briggs: Compatible with breastfeeding

Pharmacy & Therapeutic Committee- Sep 2018 Page 21 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Insulin Lispro/Insulin Lispro B Briggs: Compatible with breastfeeding Protamine and Insulin Lispro Insulin NPH B Briggs: Compatible with breastfeeding Insulin NPH and Insulin Regular B Briggs: Compatible with breastfeeding Insulin Regular B Briggs: Compatible with breastfeeding C/X (In combination Excretion in breast milk unknown/not Interferon Alfa-2a with Ribavirin) recommended C/X (In combination Interferon Alfa-2b Excreted in breast milk/not recommended with Ribavirin) Interferon Beta-1a C Excreted in breast milk/use caution Interferon Beta-1b C Excretion in breast milk unknown/not recommended Briggs: No human data; probably Iobitridol (P) B compatible Briggs: No human data; probably (P) B compatible Briggs: No human data; probably B compatible Briggs: No human data; probably Iodoquinol No data available compatible Briggs: No human data; probably B compatible Briggs: No human data; probably B compatible Excreted in breast milk/bottle feedings are Iotalamate [Iothalamate] B/C (product recommended for 24 hours after Meglumine [P] dependent) administration Excretion in breast milk unknown/use Ipratopium (Oral Inhalation) B caution Excretion in breast milk unknown/not Irbesartan D recommended Irbesartan/Hydrochlorthiazide D Excreted in breast milk/not recommended Excretion in breast milk unknown/not Irinotecan D recommended Excretion in breast milk unknown/use Iron Sucrose B caution Isoniazid C Excreted in breast milk/compatible Excretion in breast milk unknown/use Isoprenaline /isoproterenol C caution

Pharmacy & Therapeutic Committee- Sep 2018 Page 22 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Isosorbide Dinitrate C Excretion in breast milk unknown/use Isosorbide mononitrate B/C (Product Specific) caution Excretion in breast milk unknown/not X recommended Itraconazole C Excreted in breast milk/not recommended Excretion in breast milk Ivabradine ADEC*: D unknown/contraindicated Kaolin and Pectin MPR: Fetal risk is minimal AAP: Compatible with breastfeeding Ketamine ADEC*: A WHO: Compatible with breastfeeding Excretion in breast milk unknown/use (Topical) C caution Ketorolac (Ophthalmic) C Excretion in breast milk unknown/use caution Excretion in breast milk unknown/use Ketotifen (Ophthalmic) C caution Ketotifen (Systemic) C Excreted in breast milk/not recommended Labetalol C Excreted in breast milk/use caution Excretion in breast milk unknown/not Lacosamide C recommended Excretion in breast milk unknown/use Lactulose B caution LamiVUDine C Excreted in breast milk/contraindicated LamoTRIgine C Excreted in breast milk/use caution Excretion in breast milk unknown/not Lansoprazole B recommended Excretion in breast milk unknown/not LAPAtinib D recommended Excretion in breast milk unknown/use Latanoprost C caution Excretion in breast milk unknown/not Leflunomide X recommended Excretion in breast milk Lercanidipine No data available unknown/contraindicated Excretion in breast milk unknown/not X recommended Leucovorin Calcium [Calcium Excretion in breast milk unknown/use C Folinate] caution Excretion in breast milk [Leuprolide] X unknown/contraindicated Levamisole C WHO: Avoid breastfeeding

Pharmacy & Therapeutic Committee- Sep 2018 Page 23 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations LevETIRAcetam C Excreted in breast milk/not recommended Excretion in breast milk unknown/use LevOCARNitine B caution Excretion in breast milk unknown/not Levocetirizine B recommended Levodopa, Carbidopa, and C WHO: Avoid breastfeeding Entacapone C Excreted in breast milk/not recommended Levonorgestrel X Excreted in breast milk/use caution Levothyroxine A Excreted in breast milk/use caution (Systemic) B Excreted in breast milk/use caution Lidocaine (Topical) B Excreted in breast milk/use caution Lidocaine and Epinephrine B Excreted in breast milk/use caution Lidocaine and Prilocaine B Excreted in breast milk/use caution Excretion in breast milk unknown/use Linagliptin B caution C Excreted in breast milk/use caution Liothyronine A Excreted in breast milk/use caution X (Saxenda)/C Excretion in breast milk unknown/not Liraglutide (Victoza) recommended Excretion in breast milk unknown/not Lisinopril D recommended Lithium D Excreted in breast milk/not recommended Loperamide C Excreted in breast milk/not recommended Loratadine B AAP: Compatible with breastfeeding C/D ≥30 weeks Excretion in breast milk unknown/not Lornoxicam gestation recommended Excretion in breast milk unknown/not Losartan D recommended Losartan and Refer to Individual Refer to Individual Agents Hydrochlorothiazide Agents C/D ≥30 weeks Loxoprofen No data available gestation D AAP: Compatible with breastfeeding Magnesium Oxide D AAP: Compatible with breastfeeding Magnesium Sulfate D Excreted in breast milk/use caution Excretion in breast milk unknown/use C caution

Pharmacy & Therapeutic Committee- Sep 2018 Page 24 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Excretion in breast milk unknown/use Measles Virus Vaccine (Live) C caution Measles, Mumps, Rubella Excretion in breast milk unknown/use C Vaccine caution Excretion in breast milk unknown/use Mebendazole C caution Excretion in breast milk unknown/not Mebeverine No data available recommended Meclizine and Pyridoxine B Excretion in breast milk unknown MedroxyPROGESTERone X WHO: Compatible with breastfeeding Mefenamic Acid C Excreted in breast milk/not recommended Mefloquine B Excreted in breast milk/use caution D (Tablet)/X Megestrol Excreted in breast milk/not recommended (Suspension) C/D ≥30 weeks Excretion in breast milk unknown/not Meloxicam gestation recommended Excretion in breast milk unknown/not Melphalan D recommended Excretion in breast milk unknown/use Memantine B caution Meningococcal (Groups A / C / Y Excretion in breast milk unknown/use and W-135) Diphtheria Conjugate B/C (Product Specific) caution Vaccine Meningococcal Polysaccharide Excretion in breast milk unknown/use Vaccine (Groups A / C / Y and W- C caution 135) Excretion in breast milk unknown/not Menotrophins [] X recommended Excretion in breast milk unknown/use Mepivacaine and Adrenaline C caution Fetal risk cannot be Mepolizumab Infant risk cannot be ruled out ruled out Excretion in breast milk unknown/not Mercaptopurine D recommended Meropenem B Excreted in breast milk/use caution Mesalazine [Mesalamine] B/C (Product Specific) Excreted in breast milk/use caution Excretion in breast milk unknown/not Mesna B recommended MetFORMIN B Excreted in breast milk/not recommended

Pharmacy & Therapeutic Committee- Sep 2018 Page 25 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Methadone (N) C Excreted in breast milk/not recommended Excretion in breast milk unknown/use C caution X (Psoriasis, Excreted in breast milk/contraindicated Rheumatoid arthritis) Methoxy - Excretion in breast milk unknown/use C Epoetin Beta (P) caution Methyldopa B/C (Injectable) Excreted in breast milk/use caution WHO: Avoid breastfeeding Methylene Blue X Methylergometrine C Excreted in breast milk/not recommended [Methylergonovine] (C) C Excreted in breast milk/use caution MethylPREDNISolone C Excreted in breast milk/use caution B Excreted in breast milk/use caution Metolazone B Excreted in breast milk/not recommended Metoprolol C Excreted in breast milk/use caution (Systemic) B Excreted in breast milk/not recommended MetroNIDAZOLE (Topical) B Excreted in breast milk/not recommended Excretion in breast milk unknown/use (Oral) C caution Excretion in breast milk unknown/use Miconazole (Topical) No data available caution Micronized Purified Excretion in breast milk unknown/not No data available Fraction (MPFF) recommended Midazolam (C) D Excreted in breast milk/use caution Excretion in breast milk unknown/use Midodrine C caution Excretion in breast milk unknown/use Milrinone C caution Minoxidil (Sytemic) C Excreted in breast milk/not recommended Mirtazapine C Excreted in breast milk/use caution Misoprostol X Excreted in breast milk/use caution Excretion in breast milk unknown/not MitoMYcin (Systemic) X recommended MitoXANtrone D Excreted in breast milk/not recommended Excretion in breast milk unknown/use Modafinil C caution

Pharmacy & Therapeutic Committee- Sep 2018 Page 26 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Mometasone (Nasal) C Excretion in breast milk unknown/use Mometasone (Topical) C caution Excretion in breast milk unknown/use Montelukast B caution Excreted in breast milk/use caution (AAP Morphine (N) C rates compatible) Excretion in breast milk unknown/use Moxifloxacin (Ophthalmic) C caution Excretion in breast milk unknown/not Moxifloxacin (Systemic) C recommended Moxonidine No data available Excreted in breast milk/Contraindicated Excretion in breast milk unknown/use Mupirocin B caution Excretion in breast milk unknown/not Mycophenolate D recommended Naloxone B/C (Product Specific) Excretion in breast milk unknown/use caution Excretion in breast milk unknown/use Naphazoline and Pheniramine C caution Naproxen C Excreted in breast milk/not recommended Natalizumab C Excreted in breast milk/use caution Excretion in breast milk unknown/not Nebivolol C recommended Excretion in breast milk unknown/not Neomycin D recommended Excretion in breast milk unknown/use Neostigmine C caution Discontinue breastfeeding or to discontinue Netupitant and Palonosetron C the drug NIFEdipine C Excreted in breast milk/not recommended NiMODipine C Excreted in breast milk/not recommended Nintedanib D Excreted in breast milk/not recommended B (Contraindicated at Excreted in breast milk/not recommended Nitrofurantoin term) (infants <1 month) Excretion in breast milk unknown/use Nitroglycerin B/C (Product Specific) caution MPR: Fetal risk has Nivolumab (P) MLR: Infant risk cannot be ruled out been demonstrated Excretion in breast milk unknown/use Norepinephrine C caution

Pharmacy & Therapeutic Committee- Sep 2018 Page 27 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations X Excreted in breast milk/use caution Excretion in breast milk unknown/not Norfloxacin C recommended Excretion in breast milk unknown/use (Oral, Topical) C caution An effective contraception should be used during Ocrelizumab Contraindicated therapy and for 6 months after the last infusion. Octreotide B Excreted in breast milk/use caution Oestrogens [] X Excreted in breast milk/use caution (Conjugated/Equine, Systemic) Excretion in breast milk unknown/not Ofloxacin (Ophthalmic) C recommended Ofloxacin (Systemic) C Excreted in breast milk/not recommended OLANZapine C Excreted in breast milk/not recommended Excretion in breast milk unknown/not Olmesartan D recommended Olmesartan/Hydrochlorothiazide D Excreted in breast milk/not recommended Excretion in breast milk unknown/use Olopatadine (Ophthalmic) C caution Omalizumab (P) No data available No data available Ombitasvir/Paritaprevir/Ritonavir Excretion in breast milk unknown/not B (P) recommended Omega-3 Fatty Acids C Excreted in breast milk/use caution Omeprazole C Excreted in breast milk/use caution Omeprazole and Sodium Refer to Individual Refer to Individual Agents Bicarbonate Agents OnabotulinumtoxinA [Botulinum Excretion in breast milk unknown/use C Toxin Type A] caution Excretion in breast milk unknown/use Ondansetron B caution Excretion in breast milk unknown/use Orlistat X caution Oseltamivir C Excreted in breast milk/use caution Excretion in breast milk unknown/not Oxaliplatin D recommended

Pharmacy & Therapeutic Committee- Sep 2018 Page 28 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations OXcarbazepine C Excreted in breast milk/not recommended Excretion in breast milk unknown/use B caution OxyCODONE B/C (Product Specific) Excreted in breast milk/not recommended OxyCODONE and Paracetamol Refer to Individual Refer to Individual Agents [Acetaminophen] Agents Excretion in breast milk unknown/use Oxymorphone (N) C caution Excretion in breast milk unknown/use Oxytocin C (Product Specific) caution PACLItaxel (Conventional) D Excreted in breast milk/not recommended PACLitaxel (Protein Bound) D Excreted in breast milk/not recommended Palivizumab C No data available Excretion in breast milk unknown/use Pancrelipase C caution Excretion in breast milk unknown/not Panitumumab C recommended Pantoprazole B Excreted in breast milk/not recommended Excretion in breast milk unknown/use Papaverine C caution Excretion in breast milk unknown/use Papillomavirus (Types 16, 18) B caution Vaccine (Human, Recombinant)

Papillomavirus (Types 6, 11, 16, Excretion in breast milk unknown/use 18) Vaccine (Human, B caution Recombinant) Excretion in breast milk unknown/not Paricalcitol C recommended PARoxetine D/X (Product Specific) Excreted in breast milk/use caution Excretion in breast milk unknown/not PAZOPanib D recommended Excretion in breast milk unknown/use Pegfilgrastim C caution C/X (In combination Excretion in breast milk unknown/not Peginterferon Alfa-2a/2b with Ribavirin) recommended Excretion in breast milk unknown/use Peginterferon beta 1 A C caution Excretion in breast milk unknown/not PEMEtrexed D recommended

Pharmacy & Therapeutic Committee- Sep 2018 Page 29 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Excretion in breast milk PenicillAMINE D unknown/contraindicated Pentoxifylline C Excreted in breast milk/not recommended Excretion in breast milk unknown/use Perampanel Contraindicated caution Excretion in breast milk unknown/use Perindopril D caution Perindopril and Amlodipine D Refer to Individual Agents Excretion in breast milk unknown/not PERTuzumab D recommended Pethidine [Meperidine] (N) C Excreted in breast milk/not recommended PHENobarbitone [] B/D (Product Specific) Excreted in breast milk/use caution (C) Phenoxymethylpenicillin B MLR: Infant risk cannot be ruled out [Penicillin V] Potassium Excretion in breast milk Phentermine (C) X unknown/contraindicated Phenylephrine (Ophthalmic, Excretion in breast milk unknown/use C Systemic) caution D Excreted in breast milk/not recommended Phytomenadione [Phytonadione; C Excreted in breast milk/use caution Vitamin K] Excretion in breast milk unknown/not Pilocarpine C recommended Excretion in breast milk unknown/not Pimecrolimus C recommended Animal reproduction studies and information from human is not available. The presence of bromine in the formulation poses a Excretion in breast milk unknown/not Pinaverium theoretical risk of recommended causing neurologic effects (sedation, hypotony) to newborns if pinaverium is used late in pregnancy, though no such cases have been reported

Pharmacy & Therapeutic Committee- Sep 2018 Page 30 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Excretion in breast milk unknown/not Pioglitazone C recommended Piperacillin and Tazobactam B Excreted in breast milk/use caution Piracetam Not recommended Excreted in breast milk/Not recommended Excretion in breast milk unknown/ Decision Pirfenidone C shall be made either to discontinue breastfeeding or to discontinue the drug Excretion in breast milk unknown/use Piribedil Not recommended caution Excretion in breast milk unknown/not Pizotifen No data available recommended Excretion in breast milk unknown/use Pneumococcal Conjugate Vaccine B caution (13-Valent)

Pneumococcal Polysaccharide Excretion in breast milk unknown/use C Vaccine (23-Valent) caution

It may be used during pregnancy and breast feeding only if strictly indicated. There have not been It may be used during pregnancy and any studies of the breast feeding only if strictly indicated. risks associated with There have not been any studies of the use during pregnancy risks associated with use during pregnancy Policresulen in humans, but in humans, but animal studies have not animal studies have yield any evidence of fetal malformation. It not yield any is not known whether the active substance evidence of fetal passes into milk. malformation. It is not known whether the active substance passes into milk. Excretion in breast milk unknown/not C recommended Poliovirus Vaccine C MLR: Infant risk cannot be ruled out (Live/Trivalent/Oral)

Pharmacy & Therapeutic Committee- Sep 2018 Page 31 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Excretion in breast milk unknown/use Polyethylene Glycol 3350 C caution Potassium Acetate C MLR: Infant risk cannot be ruled out C Excreted in breast milk/not recommended Excreted in breast milk/use caution (AAP Potassium Iodide and Iodine D (Potassium Iodide) rates compatible) Excreted in breast milk/use caution (AAP Potassium Phosphate C rates compatible) Excretion in breast milk unknown/not Povidone-Iodine (Ophthalmic) C recommended Povidone-Iodine (Topical) No data available Excreted in breast milk/use caution Pralidoxime (PAM) C Excretion in breast milk unknown/use caution Excretion in breast milk unknown/not C recommended Excretion in breast milk unknown/use (Ophthalmic) C caution PrednisoLONE (Systemic) C/D (Product Specific) Excreted in breast milk/use caution Excretion in breast milk unknown/not Pregabalin C recommended Primidone D Excreted in breast milk/not recommended Procainamide C Excreted in breast milk/not recommended Prochlorperazine ADEC*: C Excretion in breast milk unknown B (Oral) Excreted in breast milk/use caution Excretion in breast milk unknown/not Promethazine C recommended Propofol B Excreted in breast milk/not recommended C Excreted in breast milk/use caution Propylthiouracil D Excreted in breast milk/use caution Excretion in breast milk unknown/use Protamine C caution Excretion in breast milk unknown/use Protirelin C caution Excreted in breast milk/use caution (AAP Pseudoephedrine ADEC*: B2 rates compatible) Safe (Not absorbed Psyllium AAP: Compatible with breastfeeding systematically) Pylera (Bismuth, Metronidazole, Contraindicated Excreted in breast milk/not recommended ) Pyrazinamide C Excreted in breast milk/use caution

Pharmacy & Therapeutic Committee- Sep 2018 Page 32 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Pyridostigmine B/C (Product Specific) Excreted in breast milk/use caution Pyridoxine (Vitamin B6) A Excreted in breast milk/compatible QUEtiapine C Excreted in breast milk/not recommended Excreted in breast milk/use caution (AAP QuiNINE C rates compatible) Excretion in breast milk unknown/use RABEprazole C caution Rabies Vaccine C Excretion in breast milk unknown Excretion in breast milk X unknown/contraindicated Excretion in breast milk unknown/not Ramipril D recommended Excretion in breast milk unknown/use Ranibizumab C caution Ranitidine B Excreted in breast milk/use caution Excretion in breast milk unknown/not Rasburicase C recommended Excretion in breast milk Regorafenib (P) D unknown/contraindicated Excretion in breast milk unknown/use Remifentanil (N) C caution Excretion in breast milk unknown/not Repaglinide C recommended Excretion in breast milk unknown/use Rho(D) Immune Globulin C caution Excretion in breast milk unknown/not Ribavirin X recommended Riboflavin, Ophthalmic No data available No data available Rifampin C Excreted in breast milk/not recommended Refer to Individual Rifampin and Isoniazid Refer to Individual Agents Agents Excretion in breast milk unknown/not Rimexolone C recommended C Excreted in breast milk/not recommended Excretion in breast milk unknown/not RiTUXimab C recommended Excretion in breast milk unknown/not Rivaroxaban C recommended Excretion in breast milk unknown/not Rivastigmine B recommended

Pharmacy & Therapeutic Committee- Sep 2018 Page 33 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Excretion in breast milk unknown/use RIZAtriptan (P) C caution Rocuronium C MLR: Infant risk cannot be ruled out Excretion in breast milk Rosuvastatin X unknown/contraindicated Rotavirus Vaccine C AAP: Compatible with breastfeeding Excretion in breast milk unknown/use Rotigotine C caution Excretion in breast milk unknown/not Salbutamol /Albuterol C recommended Salicylic Acid C Not recommended Excretion in breast milk unknown/use Saxagliptin B caution Refer to Individual Saxagliptin and MetFORMIN Refer to Individual Agents Agents Secukinumab B Infant risk cannot be ruled out Excretion in breast milk unknown/not Selegiline C recommended Senna C AltMedDex®; Micromedex®: Compatible Sertaconazole C Excretion in breast milk unknown/use caution Sertraline C Excreted in breast milk/use caution Sevelamer C MLR: Infant risk is minimal MLR: Infant risk cannot be ruled out (for 24 Sevoflurane B hours after anesthesia) Excretion in breast milk unknown/use Sildenafil B caution Excretion in breast milk unknown/not Sulfadiazine B recommended Silymarin No data available No data available Safe (Not absorbed Simeticone [Simethicone] AAP: Compatible with breastfeeding systematically) Excretion in breast milk Simvastatin X unknown/contraindicated Excretion in breast milk unknown/use SitaGLIPtin B caution Refer to Individual Sitagliptin and Metformin Refer to Individual Agents Agents Sodium Acetate C Excreted in breast milk/compatible Sodium Bicarbonate C Excreted in breast milk/compatible

Pharmacy & Therapeutic Committee- Sep 2018 Page 34 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Sodium Chloride C Excreted in breast milk/use caution Sodium Cromoglicate [Cromolyn] Excretion in breast milk unknown/use B (Ophthalmic) caution Sodium Phosphate C Excreted in breast milk/compatible Excretion in breast milk unknown/use Sodium Polystyrene Sulfonate C caution Excretion in breast milk Sodium Stibogluconate X unknown/contraindicated Sofosbuvir/Ledipasvir (P) B MLR: Infant risk cannot be ruled out Excretion in breast milk unknown/not C recommended B/C (Depending upon Excretion in breast milk unknown/use Somatropin manufacturer) caution Excretion in breast milk unknown/not SORAfenib D recommended Sotalol B Excreted in breast milk/not recommended Spironolactone C Excreted in breast milk/not recommended Streptomycin D Excreted in breast milk/not recommended Excretion in breast milk unknown/use Sucralfate B caution Excretion in breast milk unknown/use SUFentanil (N) C caution Sugammadex No data available Excretion in breast milk unknown SulfADIAZINE C Excreted in breast milk/contraindicated SulfaSALAzine B Excreted in breast milk/use caution Not recommended Excreted in breast milk/not recommended SUMAtriptan C Excreted in breast milk/not recommended Excretion in breast milk unknown/not SUNItinib D recommended Suxamethonium Excretion in breast milk unknown/use C [Succinylcholine] caution TACrolimus (Systemic, Topical) C Excreted in breast milk/not recommended Excretion in breast milk unknown/use Tadalafil B caution Excretion in breast milk unknown/ Decision Tafacitinib C shall be made either to discontinue breastfeeding or to discontinue the drug Talc (Sterile) B Excretion in breast milk unknown

Pharmacy & Therapeutic Committee- Sep 2018 Page 35 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Excretion in breast milk unknown/not D recommended Tamsulosin B MLR: Infant risk cannot be ruled out Excretion in breast milk unknown/use Teicoplanin Not recommended caution B/X (in combination Excretion in breast milk unknown/not Telaprevir with ribavirin) recommended Excretion in breast milk unknown/not Telmisartan D recommended Telmisartan and Refer to Individual Refer to Individual Agents Hydrochlorothiazide Agents Excretion in breast milk unknown/not TEMOzolomide D recommended Excretion in breast milk unknown/not Temsirolimus D recommended Tenofovir B Excreted in breast milk/contraindicated Terbinafine (Systemic) B Excreted in breast milk/not recommended Excretion in breast milk unknown/not Teriflunomide X recommended Excretion in breast milk unknown/not Teriparatide C recommended X Excreted in breast milk/contraindicated Excretion in breast milk unknown/use Tetanus Toxoid (Adsorbed) C caution Excretion in breast milk unknown/use Tetracaine [Amethocaine] C caution Tetracosactide [Tetracosactrin, Excretion in breast milk unknown/use C Cosyntropin] caution Excretion in breast milk unknown/use Tetrastarch C caution Excretion in breast milk unknown/not X recommended Theophylline C Excreted in breast milk/compatible Thiamine A Excreted in breast milk/use caution Excretion in breast milk unknown/use Thyrotropin Alfa C caution Excretion in breast milk X unknown/contraindicated Ticagrelor C MLR: Infant risk cannot be ruled out

Pharmacy & Therapeutic Committee- Sep 2018 Page 36 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Excretion in breast milk unknown/use Tigecycline D caution Excreted in breast milk/consider risk: Timolol C benefit Tinidazole C Excreted in breast milk/contraindicated Excretion in breast milk unknown/use Tinzaparin B caution Tiotropium C Excretion in breast milk unknown/use caution Excretion in breast milk unknown/not Tirofiban B recommended TiZANidine C Excretion in breast milk unknown Tobramycin (Ophthalmic) B Not recommended Tobramycin and Dexamethasone Excretion in breast milk unknown/use C (Ophthalmic) caution Excretion in breast milk unknown/not Tocilizumab C recommended Excretion in breast milk unknown/not Tofacitinib Not recommended recommended Excretion in breast milk unknown/not C recommended D Excreted in breast milk/use caution Excretion in breast milk unknown/not Topotecan D recommended Refer to Individual Trace Elements Refer to Individual Agents Agents TraMADol (C) C Excreted in breast milk/not recommended Tranexamic Acid B Excreted in breast milk/use caution Excretion in breast milk unknown/not Trastuzumab D recommended Excretion in breast milk unknown/use Travoprost C caution Excretion in breast milk unknown/use Tretinoin (Topical) D caution (Systemic) C Excreted in breast milk/use caution Excretion in breast milk unknown/use Triamcinolone (Topical) C caution Excretion in breast milk unknown/use Trihexyphenidyl C caution Excretion in breast milk unknown/not Trimetazidine No data available recommended

Pharmacy & Therapeutic Committee- Sep 2018 Page 37 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Trimethoprim C Excreted in breast milk/use caution Triprolidine ADEC*: A MLR: Infant risk is minimal Excretion in breast milk unknown/not (LHRH) X indicated for use in women Excretion in breast milk unknown/use Tropicamide C caution Excretion in breast milk unknown/use Trospium C caution Excretion in breast milk unknown/use Trypan Blue C caution Tuberculin Test C No data available Excretion in breast milk unknown/use Typhoid Vaccine C caution Umeclindium bromide and Excretion in breast milk unknown/use C Vilanterol caution B/C (Product Specific) Excretion in breast milk unknown/use caution Excretion in breast milk unknown/use Ursodiol B caution Excretion in breast milk unknown/use Ustekinmab B caution ValACIclovir [ValACYclovir] B Excreted in breast milk/use caution Excretion in breast milk unknown/not ValGANciclovir C recommended X (Migraine Valproic Acid and Derivatives prophylaxis)/D (All Excreted in breast milk/use caution other indications) Excretion in breast milk unknown/not Valsartan D recommended Valsartan and Refer to Individual Refer to Individual Agents Hydrochlorothiazide Agents Discontinue as soon Excretion in breast milk unknown/not Valsartan and Sacubitril as possible once recommended pregnancy is detected Vancomycin B (Oral)/C (Injection) Excreted in breast milk/not recommended Excretion in breast milk unknown/not Varenicline C recommended MPR: Fetal risk Excretion in breast milk unknown/use Varicella Zoster Vaccine cannot be ruled out caution Excretion in breast milk unknown/use Vasopressin C caution

Pharmacy & Therapeutic Committee- Sep 2018 Page 38 of 39

Department of Pharmaceutical Care

Drug Use in Pregnancy & Lactation

Generic Name Pregnancy Category Breast Feeding Considerations Vedolizumab B Infant risk cannot be ruled out Venlafaxine C Excreted in breast milk/not recommended Verapamil C Excreted in breast milk/not recommended Vigabatrin C Excreted in breast milk/not recommended Excretion in breast milk unknown/not VILDAgliptin Not recommended recommended Refer to Individual VILDAgliptin and MetFORMIN Refer to Individual Agents Agents Excretion in breast milk unknown/not VinBLAStine D recommended Excretion in breast milk unknown/not VinCRIStine D recommended Excretion in breast milk unknown/not Vinorelbine D recommended Excreted in breast milk/use caution (AAP Vitamin B - Complex A rates compatible) Vitamin E A MLR: Infant risk cannot be ruled out Excretion in breast milk unknown/not Voriconazole D recommended Vortioxetine C Data not available D (Mechanical Heart Warfarin Valves)/X (Other Not excreted in breast milk/use caution Indications) Xylometazoline C MLR: Infant risk cannot be ruled out Zaleplon C Excreted in breast milk/not recommended Zinc Sulfate C Excreted in breast milk/compatible Excretion in breast milk unknown/not Zoledronic acid D recommended (C) C Excreted in breast milk/use caution

Pharmacy & Therapeutic Committee- Sep 2018 Page 39 of 39