a, 5762??
Annex to Breastfeeding Counselling: A Training Course
—
BREASTFEEDING AND MATERNAL MEDICATION
Recommendations for Drugs in the Eighth WHO Model List of Essential Drugs
—
Division at Diarrhoeal and Acute Respiratory Disease Control
U N I c E F World Health Organization
a, 5762??
Annex to Breastfeeding Counselling: A Training Course
—
BREASTFEEDING AND MATERNAL MEDICATION
Recommendations for Drugs in the Eighth WHO Model List of Essential Drugs
—
Division at Diarrhoeal and Acute Respiratory Disease Control
U N I c E F World Health Organization
a, 5762??
Annex to Breastfeeding Counselling: A Training Course
—
BREASTFEEDING AND MATERNAL MEDICATION
Recommendations for Drugs in the Eighth WHO Model List of Essential Drugs
—
Division at Diarrhoeal and Acute Respiratory Disease Control
U N I c E F World Health Organization
This document is not a formal publication of the World Health Organization (WHO) or the United Nations Children's Fund (UNICEF), and all rights are reserved by the organizations. The document may, however, be freely reviewed, abstracted, reproduced and translated, in part or in whole, but not for sale nor for use in conjunction with commercial purposes.
The views expressed in documents by named authors are solely the responsibilities of those authors.
© World Health Organization, 1995
Secretariat Division of Diarrhoeal and Acute Respiratory Disease Control World Health Organization CH-1211 Geneva 27 Switzerland
UNICEF, 1995
Nutrition Section (H-10F) UNICEF 3 United Nations Plaza New York, NY 10017 USA
We thank the staff of the Division of Drug Management and Policies who contributed much time and valued expertise to the development of this document.
Recommendations for drugs in the Eighth WHO Model List of Essential Drugs
Contents
Introduction 1
How to use the list 1
How drugs are classilied tor breastteeding 1
Some additional considerations 3
References 4
List of drugs
1. Anaesthetics 5
1.1 General anaesthetics and oxygen 5 1.2 Local anaesthetics 5 1.3 Preoperative medication 5
2. Analgesics, antipyretics, non-steroidal anti-inflammatory drugs 6 and drugs to treat gout
2.1 Non-opioids 6 2.2 Opioid analgesics 6
3. Antiallergics and drugs used in anaphylaxis 7
4. Antidotes and other substances used in poisoning 7
4.1 General 7 4.2 Specific 7
5. Antiepileptics 8
6. Anti-infective drugs 8
6.1 Anthelminthics 8
6.1.1 Intestinal anthelminthics 8 6.1.2 Antifilaria/s 9 6.1.3 Antischistosomals 9
Breastfeeding and Maternal Medication
10.
11.
12.
6.2 Antibacterials
6.2.1 Penicillins 6.2.2 Other antibacterials 6.2.3 Antileprosy drugs 6.2.4 Antituberculosis drugs
6.3 Antifungal drugs
6.4 Antiprotozoal drugs
6.4.1 Antiamoebic and antigiardiasis drugs 6.4.2 Antileishmaniasis drugs 6.4.3 Antimalarial drugs 6.4.4 Antitrypanosamal drugs
6.5 Insect repellents
Antimigraine drugs
Antineoplastic drugs and immunosuppressant drugs used in palliative care
8.1 Immunosuppressant drugs 8.2 Cytotoxic drugs 8.3 Hormones and antihormones
Antiparkinsonism drugs
Drugs affecting the blood
10.1 Antianaemia drugs 10.2 Drugs affecting coagulation
Blood products and plasma substitutes
11.1 Plasma substitutes 11.2 Plasma fractions for specific uses
Cardiovascular drugs
12.1 Antianginal drugs 12.2 Antidysrhythmic drugs 12.3 Antihypertensive drugs 12.4 Cardiac glycosides 12.5 Drugs used in vascular shock 12.6 Antithrombotic drugs
10 11 11
11
12
12
12 13
13
14
14
Recommendations tor drugs in the Eighth WHO Model List of Essential Drugs
13.
14.
15.
16.
17.
18.
Dermatological drugs (topical)
13.1 Antifungal drugs 13.2 Anti-infective drugs 13.3 Anti-inflammatory and antipruritic drugs 13.4 Astringent drugs 13.5 Keratoplastic and keratolytic agents 13.6 Scabicides and pediculicides 13.7 Ultraviolet-blocking agents
Diagnostic agents
14.1 Ophthalmic drugs 14.2 Radiocontrast media
Disintectants and antiseptics
15.1 Antiseptics 15.2 Disinfectants
Diuretics
Gastrointestinal drugs
17.1 Antacids and other antiulcer drugs 17.2 Antiemetic drugs 17.3 Antihaemorrhoidal drugs 17.4 Anti-inflammatory drugs 17.5 Antispasmodic drugs 17.6 Cathartic drugs 17.7 Drugs used in diarrhoea
Hormones, other endocrine drugs and contraceptives
18.1 Adrenal hormones and synthetic substitutes 18.2 Androgens 1 8.3 Contraceptives
18.3.1 Hormonal contraceptives 18.3.2 Intrauterine devices 18.3.3 Barrier methods
18.4 Estrogens 18.5 Insulins and other antidiabetic agents 18.6 Ovulation inducers 18.7 Progestogens 18.8 Thyroid hormones and antithyroid drugs
19
19 19 19 19 19 20 20
20
20 20
21
21 21
21
Breastfeeding and Maternal Medication
19.
20.
22.
23.
24.
25.
26.
27.
lmmunologicals
19.1 Diagnostic agents 19.2 Sera and immunoglobulins 19.3 Vaccines
19.3.1 For universal immunization 19.3.2 For specific groups of individuals
Muscle relaxants (peripherally acting) and cholinesterase inhibitors
Ophthalmological preparations
21.1 Anti-infective agents 21.2 Anti-inflammatory agents 21.3 Local anaesthetics 21.4 Miotics and antiglaucoma drugs 21 .5 Mydriatics
Oxytocics and antioxytocics
22.1 Oxytocics 22.2 Antioxytocics
Peritoneal dialysis solution
Psychotherapeutic drugs
24.1 Drugs used in psychotic disorders 24.2 Drugs used in mood disorders 24.3 Drugs used in generalized anxiety disorders and for sedation 24.4 Drugs used for obsessive-compulsive disorders and for panic attacks
Drugs acting on the respiratory tract
25.1 Antiasthmatic drugs 25.2 Antitussives
Solutions correcting water, electrolyte and acid-based disturbances
26.1 Oral rehydration 26.2 Parenteral 26.3 Miscellaneous
Vitamins and minerals
Alphabetical list 01 essential drugs
E
26
26
26
26 26
27
27
27 27 27 27 27
28
28
28
28
28 29
29
29
29 30
38
30 30 30
31
33
Recommendations for drugs in the Eighth WHO Model List of Essential Drugs
Introduction
As a health worker you may need to decide whether a mother who is breastfeeding and who needs treatment with drugs can take the necessary medication and still continue to breastfeed safely. There are very few ldnds of treatment during which breastfeeding is absolutely contraindicated. However, there are some drugs which a mother may need to take which sometimes cause side-effects in the baby. You need to be aware which drugs these are. The summary box "Breastfeeding and Mother's Medication" on page 3 provides a preliminary guide. This booklet gives more detailed information about specific drugs from the Eighth Model List of Essential Drugs.
How to use the list
The drugs are listed in groups according to how they are used and the groups are listed alphabetically, in the same way as in the Eighth Model List of Essential Drugs.
In order to find a particular drug, first look in the index and find the numbers of the sections in which the drug is listed. Some drugs appear in several sections under separate headings because they are used for different conditions. Find the section under the appropriate heading (for example, atropine is mentioned as a solution under 21.5 mydriatics and as an injection under 1.3 preoperative medication).
Read the text related to breastfeeding and compare the drug with others listed under the same heading. Decide whether the drug that you have selected is the best choice. For example, if you want to give indometacin as a pain-killer, you will find under 2.1 non-opioids that ibuprofen is a better choice for a breastfeeding mother.
How drugs are classified for breastfeeding
The following classifications are used in the list:
1. Compatible with} breastfeeding
Drugs are classified as compatible with breastfeeding if there are no known or theoretical contraindications for their use, and it is considered safe for the mother to take the drug and continue to breastfeed.
El
Breastfeeding and Maternal Medication
2. Compatible with breastfeeding. Monitor intant ior side-effects...
Drugs are classified in this way if they could theoretically cause side—effects in the infant but have either not been observed to do so or have only occasionally caused mild side-effects. Inform the mother about any possible side-effects, reassure her that they are unusual, and ask her to return if they occur or if she is worried.
If side-effects do occur, stop giving the drug to the mother, and if necessary find an alternative. If the mother cannot stop taking the drug, she may need to stop breastfeeding and feed her baby artificially until her treatment is completed. Help her to express her breastmilk to keep up the supply so that she can breastfeed again after she stops taking the drug.
Avoid it possible. Monitor infant for side-etlects
Drugs are classified in this way if they have been reported to cause side- effects in the infant, especially if the side-effects could be serious. Use these drugs only when they are really essential for the mother’s treatment and when no safer alternative is available. Allow the mother to continue breastfeeding but give her clear instructions about observing the baby and arrange for frequent follow-up. If side-effects occur, stop the drug. If it is not possible to stop giving the drug, stop breastfeeding and feed the baby artificially until treatment is completed. Help her to express her breastmilk to keep up the supply so that she can breastfeed again after she stops taking the drug.
Avoid it possible. May inhibit lactation.
Drugs classified this way may reduce breastmilk production and, if possible, they should be avoided. However, if a mother has to take one of these drugs for a short period, she does not need to give artificial milk to her baby. She can off set the possible decrease in milk production by encouraging her baby to suckle more frequently.
Avoid.
Drugs are classified in this way if they can have dangerous side-effects on the baby. They should not be given to a mother while she is breastfeeding. If they are essential for treating the mother, she should stop breastfeeding until treatment is completed. If treatment is prolonged, she may need to stop breastfeeding altogether. There are very few drugs in this category apart from anticancer drugs and radioactive substances.
Recommendations for drugs in the Eighth WHO Model List of Essential Drugs
Some additional considerations
The safety of certain drugs also depends on the age of the infant. Premature babies and infants less than 1 month of age have a different capacity to absorb and excrete drugs than older infants. Thus, in general, extra caution is needed for these infants. For some drugs, specific information is available with respect to age and you will find this mentioned in the list. You may need to give a breastfeeding mother a drug that is not included in this list. Unless the drug falls into a category with clear contraindications (for example cytotoxic drugs), advise the mother to continue breastfeeding and ask her to come back if she notices anything worrying about her infant.
Breastfeeding and Mother's Medication
Breastfeeding contraindicated
Side-effects possible Monitor baby for drowsiness
Use alternative drug if possible
Monitor baby for jaundice
Use alternative drug (may inhibit lactation)
Safe in usual dosage Monitor baby
Continue breastleeding:
Anticancer drugs (antimetabolites); Radioactive substances (stop breastfeeding temporarily)
Psychiatric drugs and anticonvulsants
Chloramphenicol, tetracyclines, metronidazole quinolone antibiotics (e.g. ciprofloxacin)
Sulfonamides, dapsone sulfamethoxazole+trimethoprim (cotrimoxazole) sulfadoxine+pyrimethamine (Fansidar)
Estrogens, including estrogen-containing contraceptives thiazide diuretics, ergometrine
Most commonly used drugs: analgesics and antipyretics: short courses of paracetamol, acetylsalicylic acid, ibuprofen; occasional doses of morphine and pethidine. antibiotics: ampicillin, amoxicillin, cloxacillin and other penicillins erythromycin, anti-tuberculars. anti-leprotics (see dapsone above). antimalarials (except mefloquine, Fansidar), anthelminthics, antifungals. bronchodilators (e.g. salbutamol). corticosteroids, antihistamines, antacids, drugs for diabetes, most antihypertensives, digoxin, nutritional supplements of iodine, iron, vitamins.
(adapted from 'Breastfeeding counselling: A training course', WHO/CDR/93.3-6)
Breastfeeding and Maternal Medication
References
Eighth Model List of Essential Drugs. In: The Use of Essential Drugs. World Health Organization (Technical Report Series No. 850), 1995.
Bennett PN, Matheson I, Dukes NMG et al, eds. Drugs and human lactation. Elsevier Science Publishers B.V., Amsterdam, 1988.
Briggs, GG, Freeman RK, Yaffe 8]. Drugs in pregnancy and lactation, Third edition. Williams and Wilkins, Baltimore, MD, 1990.
American Academy of Paediatrics, Committee on Drugs, Transfer of drugs and other chemicals in human milk. Pediatrics, 93:137—150, 1994.
British Medical Association, Royal Pharmaceutical Society of Great Britain. British Medical Formulary, No. 29, March 1995.
Breastfeeding counselling: A training course. World Health Organization (WHO/CDR/93.3-6), 1993.
Recommendations for drugs in the Eighth WHO Model List of Essential Drugs
Drug Recommendation during lactation
1. Anaesthetics
General information: If a procedure requires anaesthesia, help the mother to express her breastmilk in advance and store it in a refrigerator so that her baby can be fed her expressed breastmilk by cup while she is undergoing the operation and recovering from the anaesthesia.
1.1 General anaesthetics and oxygen
ether :1 Compatible with breastfeeding. halothane :1 Compatible with breastfeeding. ketamine u Compatible with breastfeeding. nitrous oxide :1 Compatible with breastfeeding. oxygen :1 Compatible with breastfeeding. thiopental 1: Compatible with breastfeeding.
1.2 Local anaesthetics
bupivacaine :1 Compatible with breastfeeding. lidocaine a Compatible with breastfeeding.
1.3 Preoperative medication
atropine :1 Compatible with breastfeeding. Monitor infant for side-effects (drying of secretions, temperature elevation and CNS disturbance).
chloral hydrate n Compatible with breastfeeding in single dose. Monitor infant for drowsiness.
diazepam :1 Compatible with breastfeeding in single dose. Avoid giving repeated doses, if possible. Monitor infant for drowsiness. Short-acting benzodiazepines preferred.‘
morphine 1: Compatible with breastfeeding in single dose. Avoid giving repeated doses, if possible. Monitor infant for side—effects (apnoea and bradycardia).
promethazine :1 Compatible with breastfeeding in single dose.
*See Section 24.3, page 29.
Avoid giving repeated doses, if possible. Monitor infant for drowsiness.
Breastfeeding and Maternal Medication
Drug Recommendation during lactation
2. Analgesics, antipyretics, non-steroidal anti-inflammatory drugs and drugs to treat gout
2.1 Non-opioids
General information: ibuprofen and paracetamol have the best documentation on safety during breastfeeding.
acetylsalicylic acid :1 Compatible with breastfeeding in occasional doses. Avoid long-term therapy, if possible. Monitor infant for side-effects (haemolysis, prolonged bleeding time and metabolic acidosis).
allopurinol a No data available. colchicine u Avoid if possible, animal data suggest it can
alter the composition of breastmilk. ibuprofen :1 Compatible with breastfeeding. indometacin 1: Avoid if possible.
Monitor infant for convulsions. paracetamol n Compatible with breastfeeding.
2.2 Opioid analgesics
General information: Single doses of most opioids are excreted in breastmilk only in small amounts. Repeated doses may result in accumulation in the infant. Avoid repeated doses. especially if the infant is premature or less than 4 weeks old. Avoid drugs from this category if the infant has had an episode of apnoea, bradycardia or cyanosis. if given during delivery, the infant may be drowsy at birth, which may interfere with the initiation of breastfeeding.
codeine n Compatible with breastfeeding in occasional doses. Avoid repeated doses, if possible. Monitor infant for side-effects (apnoea, bradycardia and cyanosis).
morphine a Compatible with breastfeeding in occasional doses. Avoid repeated doses, if possible. Monitor infant for side-effects (apnoea, bradycardia and cyanosis).
pethidine 1: Compatible with breastfeeding in occasional ‘ doses.
Avoid repeated doses. if possible. Monitor infant for side-effects (apnoea, bradycardia and cyanosis). Side-effects occur more commonly than with morphine.
Recommendations for drugs in the Eighth WHO Model List of Essential Drugs
Drug Recommendation during lactation
4.2
Antiallergics and drugs used in anaphylaxis
chiorphenamine :1 Avoid if possible. Monitor infant for side-effects (drowsiness, irritability). May inhibit lactation.
dexamethasone u Compatible with breastfeeding in single dose. No data available about prolonged usage.
epinephrine a No data available. hydrocortisone u Compatible with breastfeeding in single dose.
No data available about prolonged usage. prednisolone :3 Compatible with breastfeeding.
Antidotes and other substances used in poisoning
General
charcoal, activated :1 Compatible with breastfeeding. ipecacuanha :1 Compatible with breastfeeding.
Specific
atropine 1: Compatible with breastfeeding. Monitor infant for side-effects (drying of secretions, temperature elevation and CNS disturbance).
deferoxamine a No data available dimercaprol n Avoid if possible. especially if the infant is
premature or less than 1 month old. Monitor infant for side-effects (haemolysis and jaundice). Avoid in G-6—PD deficient infants.
methionine a No data available. methylthioninium chloride in Avoid if possible, especially if the infant is (methylene blue) premature or less than 1 month old.
Monitor infant for side-effects (haemolysis and jaundice).
naloxone i: No data available. penicillamine a No data available. potassium ferric a No data available.
hexacyanoferrate(ll) 2H20 (prussian blue)
sodium calcium edetate a No data available. sodium nitrite a No data available. sodium thiosulfate a No data available.
Breastfeeding and Maternal Medication
Drug Recommendation during lactation
5. Antiepileptics
General information: Breastfed infants of mothers who are taking anticonvulsants sometimes develop drowsiness. For mothers who need anticonvulsants there is often little alternative. It is essential that they take their medication and it can be dangerous to change antiepileptic medicines suddenly. Breastfeeding is usually possible, but the infant must be monitored. It helps if the dose is kept as low as possible within the effective therapeutic range.
carbamazepine :1 Compatible with breastfeeding. Monitor infant for side—effects (jaundice, drowsiness, poor suckling, vomiting and poor weight gain).
diazepam :1 Compatible with breastfeeding in single dose. Avoid repeated doses, if possible". Monitor infant for drowsiness.
ethosuximide :1 Avoid if possible. Monitor infant for side-effects (drowsiness, poor suckling and poor weight gain).
phenobarbital 1: Compatible with breastfeeding. Monitor infant for side-effects (drowsiness, poor suckling and poor weight gain).
phenytoin :1 Compatible with breastfeeding. Monitor infant for side-effects (cyanosis and methaemoglobinaemia).
valproic acid 1: Compatible with breastfeeding. Monitor infant for side-effects (jaundice).
6. Anti-infective drugs
6.1 Anthelminthics
6.1.1 Intestinal anthe/minthics
General information: There are limited data available on the use of drugs in this category. However, they act mainly in the intestinal system of the mother and little is absorbed into the general system. They can be considered compatible with breastfeeding.
albendazole a Compatible with breastfeeding. levamisole 1: Compatible with breastfeeding. mebendazole :1 Compatible with breastfeeding.- niclosamide n Compatible with breastfeeding. piperazine n Compatible with breastfeeding. praziquantel a Compatible with breastfeeding. pyrantel a Compatible with breastfeeding.
’ See section 24.3, page 29
Recommendations for drugs in the Eighth WHO Model List of Essential Drugs
Drug Recommendation during lactation
6. Anti-infective drugs (continued)
6.1.2 Antifilarials
diethylcarbamazine a No data available. ivermectin a No data available. suramin sodium :1 No data available.
6.1.3 Antischistosoma/s
metrifonate :1 Compatible with breastfeeding. oxamniquine n Compatible with breastfeeding. praziquantel u Compatible with breastfeeding.
6.2 Antihacterials
General information: If the drug is excreted in breastmilk, there is a possibility of altering the infant’s intestinal flora. Monitor the infant for gastrointestinal disturbances, such as thrush and diarrhoea. If they occur, stop the drug and choose an alternative if necessary. Continue breastfeeding.
6.2.1 Penicillins
General information: Breastfeeding is generally sate. Theoretically, penicillins can cause an allergic reaction in the infant. if the infant develops a rash, it could be a sign of allergy. Stop the drug and choose an alternative if necessary. Continue breastfeeding. Warn the mother that the infant should not be given the drug in future.
amoxicillin u Compatible with breastfeeding. ampicillin n Compatible with breastfeeding. benzathine benzylpenicillin a Compatible with breastfeeding. benzylpenicillin :1 Compatible with breastfeeding. cloxacillin :1 Compatible with breastfeeding. phenoxymethylpenicillin :3 Compatible with breastfeeding. piperacillin 1: Compatible with breastfeeding.
Dprocaine benzylpenicillin Compatible with breastfeeding.
Breastfeeding and Maternal Medication
Drug Recommendation during lactation
6. Anti-infective drugs (continued)
6.2.2 Other antibacterials
chloramphenicol
ciprofloxacin clindamycin
doxycycline
erythromycin gentamycin
metronidazole
nalidixic acid
nitrofurantoin
spectinomycin ' sulfadimidine
Avoid if possible, especially if the infant is less than 1 month old. Monitor the infant for side-effects (haemolysis and jaundice). Theoretically there is a risk of bone-marrow depression, but this has never been reported. Avoid if possible, until more data are available. Avoid if possible. Monitor infant for diarrhoea or bloody stools. Avoid if possible. Possibility of staining the infant's teeth. Single dose is probably safe. Compatible with breastfeeding. Compatible with breastfeeding. Monitor infant for thrush and diarrhoea. Avoid if possible. Animal data suggest it may be carcinogenic. If given in single dose of 2 grams, discontinue breastfeeding for 12 hours. Help the mother to express her breastmilk in advance and store it in a refrigerator so that her baby can be fed by cup during that time. Avoid if possible, especially if the infant is premature or less than 1 month old. Monitor the infant for side—effects (haemolysis and jaundice). Avoid in infants with G—6-PD deficiency. Compatible with breastfeeding for healthy, full term infants. Avoid if possible if the infant is premature or less than 1 month old. Monitor the infant for side-effects (haemolysis and jaundice). Avoid in infants with G-6-PD deficiency. No data available. Compatible with breastfeeding for older, healthy, full term infants. Avoid if possible if the infant is premature or less than 1 month old. Monitor the infant for side-effects (haemolysis and jaundice). Avoid in infants with G-6-PD deficiency.
Recommendations for drugs in the Eighth WHO Model List of Essential Drugs
Drug Recommendation during lactation
6. Anti-infective drugs (continued)
sulfamethoxazole :1 Compatible with breastfeeding for older, + trimethoprim healthy full term infants. (cotrimoxazole) Avoid if possible if the infant is premature or
less than 1 month old. Monitor the infant for side-effects (haemolysis and jaundice). Avoid in infant with G-6-PD deficiency.
tetracycline :3 Avoid if possible. Possibility of staining the infant’s teeth. Short course of 3 days is probably safe.
trimethoprim. 1: Compatible with breastfeeding.
6.2.3 Antileprosy drugs
clofazimine a May cause skin discoloration, which is reversible.
dapsone u Compatible with breastfeeding. Monitor for side-effects (haemolysis and jaundice), especially if the infant is premature or less than 1 month old. Avoid in infants with G-6 PD deficiency.
rifampicin :1 Compatible with breastfeeding.
6.2.4 Antituberculosis drugs
General information: If the baby develops significant jaundice, stop or change the drug if possible. if this is not possible, it may be necessary to consider feeding the baby artificially.
ethambutol n Compatible with breastfeeding. Monitor the infant for jaundice.
isoniazid n Compatible with breastfeeding. Monitor the infant for jaundice.
pyrazinamide u Compatible with breastfeeding. Monitor the infant for jaundice.
rifampicin :1 Compatible with breastfeeding. Monitor the infant for jaundice.
rifampicin + isoniazid u Compatible with breastfeeding. Monitor the infant for jaundice.
streptomycin :2 Compatible with breastfeeding. Monitor the infant for thrush and diarrhoea.
thioacetone + isoniazid a Compatible with breastfeeding. Monitor the infant for jaundice and generalised skin rashes.
[1}]
Breastfeeding and Maternal Medication
Drug Recommendation during lactation
6.3
6.4
6.4. 1
6.4.2
6.4.3
Anti-infective drugs (continued)
Antitungal drugs
amphotericin B flucytosine griseotulvin ketoconazole nystatin
Antiprutozoal drugs
D D
D D
D
No data available. No data available. No data available. No data available. Compatible with breastfeeding.
Antiamoebic and antigiardiasis drugs
chloroquine
diloxanide metronidazole
Antileishmaniasis drugs
meglumine antimoniate pentamidine
Antimalarial drugs
chloroquine
mefloquine
Compatible with breastfeeding. Monitor for side-effects (haemolysis and jaundice), especially if the infant is premature or less than 1 month old. Avoid in G-6-PD deficient infants. No data available. Avoid if possible. Animal data suggest it may be carcenogenic. If given in single dose of 2 grams, discontinue breastfeeding for 12 hours. Help the mother to express her breastmilk in advance and store it in a refrigerator so that the baby can be fed by cup during that time.
Compatible with breastfeeding. Compatible with breastfeeding.
Compatible with breastfeeding. Monitor for side-effects (haemolysis and jaundice), especially if the infant is premature or less than 1 month old. Avoid in G-6-PD deficient infants. Avoid if possible until more data are available.
Recommendations for drugs in the Eighth WHO Model List at Essential Drugs
Drug Recommendation during lactation
6.4.4
Anti-iniective drugs (continued)
primaquine
proguanil quinine
sulfadoxine + pyrimethamine (Fansidar)
tetracycline
Antitlypanosomal drugs
benznidazole eflornithine melarsoprol nifurtimox pentamidine suramin sodium
Insect repellents
diethyltoluamide
Compatible with breastfeeding. Monitor for haemolysis and jaundice, especially if the infant is premature or less than 1 month old. Avoid in G—6—PD deficient infants. No data available. Compatible with breastfeeding. Monitor for haemolysis and jaundice, especially if the infant is premature or less than 1 month old. Avoid in G-6-PD deficient infants. Compatible with breastfeeding for older, healthy, full-term infants. Avoid if possible if the infant is premature or less than 1 month old. Monitor the infant for side-effects (haemolysis and jaundice). Avoid in G-6—PD deficient infants. Avoid it possible. Possibility of staining the infants' teeth. However, short course of 3 days is probably sale.
No data available. No data available. No data available. No data available. No data available. No data available.
Compatible with breastfeeding. Avoid direct contact of the infant with the repellant.
Breastfeeding and Maternal Medication
Drug Recommendation during lactation
7. Antimigraine drugs
acetylsalicylic acid :1 Compatible with breastfeeding in occasional doses. Avoid long term therapy, if possible. Monitor the infant for side-effects (haemolysis, prolonged bleeding time and metabolic acidosis).
ergotamine :2 Avoid if possible. Monitor the infant for side-effects (ergotism).
paracetamol :1 Compatible with breastfeeding. propranolol :1 Compatible with breastfeeding.
Monitor the infant for side-effects (bradycardia, hypoglycaemia and cyanosis).
8. Antineoplastic drugs and immunosuppressant drugs used in palliative care
8.1 lmmunosuppressant drugs
General information: Breastfeeding is contraindicated when a mother has to take a drug which belongs to this category.
azathioprine n Avoid breastfeeding. ciclosporin 1: Avoid breastfeeding.
Recommendations for drugs in the Eighth WHO Model List of Essential Drugs
Drug Recommendation during lactation
8.2
Antineoplastic drugs and immunosuppressantdrugs used in palliative care (continued)
Cytotoxic drugs
General information: Breastfeeding is contraindicated when a mother has to take a drug which belongs to this category.
8.3
asparaginase bleomycin calcium folinate cisplatin chlormethine (mustine) cyclophosphamide cytarabine dacarbazine dactinomycin doxorubicin etoposide fluorouracil levamisole mercaptopurine methotrexate procarbazine vinblastine vincristine
Hormones and antihormones
prednisolone tamoxifen
Antiparkinsonism drugs
biperiden levodopa + carbidopa
D D
D D
D D
D D
D U
D D
D D
D D
U D
Avoid breastfeeding. Avoid breastfeeding. Compatible with breastfeeding. Avoid breastfeeding. Avoid breastfeeding. Avoid breastfeeding. Avoid breastfeeding. Avoid breastfeeding. Avoid breastfeeding. Avoid breastfeeding. Avoid breastfeeding. Avoid breastfeeding. Avoid breastfeeding. Avoid breastfeeding. Avoid breastfeeding. Avoid breastfeeding. Avoid breastfeeding. Avoid breastfeeding.
Compatible with breastfeeding. Avoid.
No data available. Avoid if possible. Levodopa may inhibit lactation.
Breastfeeding and Maternal Medication
Drug Recommendation during lactation
10. _
10.1
10.2
11.
11.1
11.2
Drugs affecting the blood
Antianaemia drugs
ferrous salt 1: Compatible with breastfeeding. ferrous salt + folic acid :1 Compatible with breastfeeding. folic acid :1 Compatible with breastfeeding. hydroxocobalamin u Compatible with breastfeeding. iron dextran :1 Compatible with breastfeeding.
Drugs affecting coagulation
desmopressin :3 Compatible with breastfeeding. heparin r: Compatible with breastfeeding. phytomenadione :3 Compatible with breastfeeding. protamine sulfate a No data available. warfarin :1 Compatible with breastfeeding.
Blood products-and plasma substitutes
Plasma substitutes
dextran 70 a Compatible with breastfeeding. polygeline :2 Compatible with breastfeeding.
Plasma fractions for specific uses
albumin, human :1 Compatible with breastfeeding. factor VIII concentrate :1 Compatible with breastfeeding. factor IX complex :1 Compatible with breastfeeding.
concentrate
Recommendations for drugs in the Eighth WHO Model List of Essential Drugs
Drug Recommendation during lactation
12.
12.1
12.2
12.3
Cardiovascular drugs
Antianginal drugs
atenolol.
glyceryl trinitrate isorbide dinitrate propranolol
verapamil
Antidysrhythmic drugs
atenolol
isoprenaline lidocaine procainamide
propanolol
quinidine verapamil
Antihypertensive drugs
atenolol
captopril hydralazine
hydrochlorothiazide methyldopa
Avoid if possible, especially if the infant is premature or less than 1 month old. Monitor the infant for side—effects (bradycardia, hypotension and cyanosis). No data available. No data available. Compatible with breastfeeding. Monitor the infant for side-effects (bradycardia, hypoglycaemia and cyanosis). Compatible with breastfeeding.
Avoid if possible, especially if the infant is premature or less than 1 month old. Monitor the infant for side-effects (bradycardia, hypotension and cyanosis). No data available. Compatible with breastfeeding. Compatible with breastfeeding. However, insufficient data available on side-effects of long-term use. Compatible with breastfeeding. Monitor the infant for side—effects (bradycardia, hypoglycaemia and cyanosis). Compatible with breastfeeding. Compatible with breastfeeding.
Avoid if possible, especially if the infant is premature or less than 1 month old. Monitor the infant for side-effects (bradycardia, hypotension and cyanosis). Compatible with breastfeeding. Compatible with breastfeeding. However, insufficient data available on long-term use. Compatible with breastfeeding. Compatible with breastfeeding.
Breastfeeding and Maternal Medication
Drug Recommendation during lactation
12.
12.3
12.4
12.5
12.6
Cardiovascular drugs (continued)
Antihyperlensive drugs (continued)
nifedipine , :1 Compatible with breastfeeding. However insufficient data on long term use.
propra'nolol :1 Compatible with breastfeeding. Monitor the infant for side—effects (bradycardia, hypoglycaemia and cyanosis).
reserpine u Avoid. sodium nitroprusside a No data available.
Cardiac glycosides
digitoxin :1 Compatible with breastfeeding. digoxin u Compatible with breastfeeding.
Drugs used in vascular shock
dopamine a No data available.
Antithrombotic drugs
acetylsalicylic acid 1: Compatible with breastfeeding in small doses used for anti-thrombosis. Avoid repeated administration in normal doses if possible. Monitor the infant for side—effects (haemolysis, prolonged bleeding time and metabolic acidosis).
streptokinase :1 No data available.
Recommendations for drugs in the Eighth WHO Model List of Essential Drugs
Drug Recommendation during lactation
13. Dermatological drugs (topical)
General Information: Topical preparations are not usually absorbed in significant amounts and can usually be used safely during breastfeeding.
13.1
13.2
13.3
13.4
13.5
Antifungal drugs benzoic acid + salicylic acid miconazole selenium sulfide sodium thiosulfate D
D I’ J E
I
Anti-infective drugs
methylrosanilinium chloride in (gentian violet)
neomycin + bacitricin a silver sulfadiazine :1
Compatible with breastfeeding. Compatible with breastfeeding. Compatible with breastfeeding. Compatible with breastfeeding.
Compatible with breastfeeding.
Compatible with breastfeeding. Compatible with breastfeeding.
Anti-inflammatory and antipruritic drugs
betamethasone u calamine lotion n hydrocortisone a
Astringent drugs
aluminium diacetate
Compatible with breastfeeding. Compatible with breastfeeding. Compatible with breastfeeding.
Compatible with breastfeeding.
Keratoplastic and keratolytic agents
benzoyl peroxide coal tar dithranol fluorouracil podophyllum resin salicylic acid
Compatible with breastfeeding. Compatible with breastfeeding. Compatible with breastfeeding. Avoid. Compatible with breastfeeding. Compatible with breastfeeding.
Breastfeeding and Maternal Medication
Drug Recommendation during lactation
13. Dermatological drugs (topical) (continued)
13.6 Scabicides and pediculicides
benzyl benzoate :1 Compatible with breastfeeding. permethrin u Compatible with breastfeeding.
13.7 Ultraviolet-blocking agents
p—aminobenzoic acid. sun in Compatible with breastfeeding. protection factor 15
benzophenones, sun in Compatible with breastfeeding. protection factor 15
zinc oxide u Compatible with breastfeeding.
14. Diagnostic agents
14.1 Ophthalmic drugs
fluorescein a Avoid if possible when the infant is premature or less than 1 month old, especially when under going phototherapy.
tropicamide t: No data available.
14.2 Radiocontrast media
amidotrizoate :1 Compatible with breastfeeding. barium sulfate :1 Compatible with breastfeeding. iopanoic acid :1 Compatible with breastfeeding. meglumine iotroxate r: Compatible with breastfeeding. propyliodine n Compatible with breastfeeding.
However, iodine-containing drugs for systemic administration are a cause for concern. Monitor the infant for side-effects (hypothyroidism).
Recommendations for drugs in the Eighth WHO Model List of Essential Drugs
Drug Recommendation during lactation
15. Disinfectants and antiseptics
15.1 Antiseptics
chiorhexidine :2 Compatible with breastfeeding. hydrogen peroxide u Compatible with breastfeeding. povidone iodine u Avoid if possible repeated topical application.
Monitor the infant for side-effects (hypothyroidism).
Note: Substances for topical application that contain iodine should be used with caution during lactation because iodine can be absorbed and concentrated in breastmilk and reach levels which are toxic for the infant. Nutritional supplements of iodine given to the mother on appropriate indications are, however, safe.
15.2 Disinfectants
calcium hypochlorite :1 Compatible with breastfeeding. glutaral u Compatible with breastfeeding.
16. Diuretics
General information: Large doses of short-acting thiazide diuretics and usual doses of loop diuretics or long-acting thiazide diuretics can inhibit lactation and should be avoided, if possible.
amiloride 1: Avoid if possible. May inhibit lactation. furosemide :1 Avoid if possible. May inhibit lactation. hydrochlorothiazide a Avoid if possible. May inhibit lactation. mannitol :1 Compatible with breastfeeding. spironolactone :1 Compatible with breastfeeding.
El
Breastfeeding and Maternal Medication
Drug Recommendation during lactation
17.
17.1
17.2
17.3
17.4
17.5
Gastrointestinal drugs
Antacids and other antiulcer drugs
aluminium hydroxide cimetidine
magnesium hydroxide
Antiemetic drugs
metoclopramide
promethazine
Antihaemorrhoidal drugs
local anaesthetic, astringent and anti-inflammatory drug
Anti-inflammatory drugs
hydrocortisone
sulfasalazine
Antispasmndic drugs
atropine
Compatible with breastfeeding. Avoid if possible. Insufficient data on long-term side-effects. Compatible with breastfeeding.
Avoid if possible. Insufficient data on long-term side-effects (possible defects in neural development in newborn animals). Increases breastmilk production. Compatible with breastfeeding in single dose. Avoid repeated doses, if possible. Monitor the infant for drowsiness.
Compatible with breastfeeding.
Compatible with breastfeeding in single dose. No data available on prolonged use. Avoid if possible, especially if the infant is premature or less than 1 month old. Monitor the infant for side-effects (bloody diarrhoea, haemolysis and jaundice). Avoid in G—6—PD deficient infants.
Compatible with breastfeeding. Monitor the infant for side-effects (drying of secretions, temperature elevation and CNS disturbance).
Recommendations tor drugs in the Eighth WHO Model List of Essential Drugs
Drug Recommendation during lactation
17.
17.6
17.7
18.
18.1
18.2
Gastrointestinal drugs (continued)
Cathartic drugs
senna a Compatible with breastfeeding. However, it is only advisable to use the drug if dietary measures for treating constipation fail.
Drugs used in diarrhoea
oral rehydration salts :1 Compatible with breastfeeding. codeine u Compatible with breastfeeding in occasional
doses. Avoid repeated doses if possible. Monitor the infant for side-effects (apnoea, bradycardia and cyanosis).
Hormones, other endocrine drugs and contraceptives
Adrenal hormones and synthetic substitutes
dexamethasone :1 Compatible with breastfeeding in single dose. No data available on prolonged use.
fludrocortisone a No data available. hydrocortisone 1: Compatible with breastfeeding in single dose.
No data available on prolonged use. prednisolone 1:: Compatible with breastfeeding.
Androgens
testosterone :1 Avoid.
Breastfeeding and Maternal Medication
Drug Recommendation during lactation
18. Hormones, other endocrine drugs and contraceptives (continued)
18.3 Contraceptives
General information: The provision of hormonal contraceptives (including progestogen- only contraceptives) is discouraged during the first 6 weeks post-partum. in order to avoid exposing infants to them. If a contraceptive method is desired, a non—hormonal method should be the first choice.
18.3.1 Hormonal contraceptives
ethinylestradiol + a Avoid, if possible. May inhibit lactation. levonorgestrel
ethinylestradiol + :3 Avoid, it possible. May inhibit lactation. norethisterone
depot medroxy- :1 Compatible with breastfeeding from 6 weeks progesterone post-partum. acetate
norethisterone u Compatible with breastfeeding from 6 weeks post-partum.
norethisterone enantate :1 Compatible with breastfeeding from 6 weeks post-partum.
18.3.2 Intrauterine devices
copper-containing device :1 Compatible with breastfeeding.
18.3.3 Barrier methods
condoms with or without :1 Compatible with breastfeeding. spermicide (nonoxinol)
diaphragms with :1 Compatible with breastfeeding. spermicide (nonoxinol)
18.4 Estrogens
ethinylestradiol u Avoid, if possible. May inhibit lactation.
Recommendations for drugs in the Eighth WHO Model List of Essential Drugs
Drug Recommendation during lactation
18. Hormones, other endocrine drugs and contraceptives (continued)
18.5 lnsulins and other antidiabetic agents
General information: Some women require reduced doses of drugs in this category while breastfeeding.
insulin injection :1
intermediate acting insulin :3
tolbutamide a
18.6 Ovulation inducers
clomifene r:
18.7 Progestogens
norethisterone n medroxyprogesterone acetate in
Compatible with breastfeeding. Dosage may need to be reduced during lactation. Compatible with breastfeeding. Dosage may need to be reduced during lactation. Compatible with breastfeeding. Monitor the infant for side-effects (jaundice).
Avoid (unlikely to be needed).
Compatible with breastfeeding. Compatible with breastfeeding from 6 weeks post-partum.
18.8 Thyroid hormones and antithyroid drugs
levothyroxine a potassium iodide n
propylthiouracil :1
Compatible with breastfeeding. Avoid, if possible. Monitor the infant for side-effects (hypothyroidism) Compatible with breastfeeding.
El
Breastfeeding and Maternal Medication
Drug Recommendation during lactation
19. lmmunologicals
19.1 Diagnostic agents
tuberculin, purified protein derivative (PPD)
19.2 Sara and immunoglobulins
anti-D immunoglobulin (human)
antiscorpion sera antitetanus immunoglobulin antivenom sera diphtheria antitoxin immunoglobulin, human,
normal rabies immunoglobulin
19.3 Vaccines
19.3.1 For universal immunization
BCG vaccine (dried) diphtheria-pertussis-
tetanus vaccine diphtheria-tetanus vaccine hepatitis B vaccine measles-mumps—rubella
vaccine measles vaccine poliomyelitis vaccine
(inactivated) poliomyelitis vaccine
(live attenuated) tetanus vaccine
19.3.2 For specific groups of individuals
influenza vaccine meningococcal vaccine rabies vaccine rubella vaccine typhoid vaccine yellow fever vaccine
Compatible with breastfeeding.
Compatible with breastfeeding.
No data available. Compatible with breastfeeding. No data available. Compatible with breastfeeding. Compatible with breastfeeding.
Compatible with breastfeeding.
Compatible with breastfeeding. Compatible with breastfeeding.
Compatible with breastfeeding. Compatible with breastfeeding. Compatible with breastfeeding.
Compatible with breastfeeding. Compatible with breastfeeding.
Compatible with breastfeeding.
Compatible with breastfeeding.
Compatible with breastfeeding. Compatible with breastfeeding. Compatible with breastfeeding. Compatible with breastfeeding. Compatible with breastfeeding. Compatible with breastfeeding.
[it
Recommendations for drugs in the Eighth WHO Model List of Essential Drugs
Drug Recommendation during lactation
20.
21.
21.1
21.2
21.3
21.4
21.5
Muscle relaxants (peripherally acting) and cholinesterase. inhibitors
alcuronium chloride u neostigmine u
pyridostigmine u suxamethonium a vecuronium bromide :1
Compatible with breastfeeding. Avoid it possible in combination with atropine. Theoretically side-effects may occur. Compatible with breastfeeding. Compatible with breastfeeding. Compatible with breastfeeding.
Ophthalmological preparations
Anti-infective agents
gentamicin idoxuridine silver nitrate. tetracycline
Anti-inflammatory agents
prednisolone a
Local anaesthetics
tetracaine r:
Miotics and antiglaucoma drugs
acetazolamide u pilocarpine n timolol n
Mydriatics
atropine u epinephrine :1
Compatible with breastfeeding. Compatible with breastfeeding. Compatible with breastfeeding. Compatible with breastfeeding.
Compatible with breastfeeding.
Compatible with breastfeeding.
Compatible with breastfeeding. Compatible with breastfeeding. Compatible with breastfeeding.
Compatible with breastfeeding. Compatible with breastfeeding.
E
Breastfeeding and Maternal Medication
Drug Recommendation during lactation
22.1
22.2
23.
24.
24.1
Oxvtocics and antioxtooies
ntocies
ergometrine u Compatible with breastfeeding in single dose. Avoid repeated doses if possible. May inhibit lactation.
oxytocin a Compatible with breastfeeding during short term use. Avoid prolonged use. May cause physiological dependence of the oxytocin reflex in the mother.
Antioxytocies
salbutamol :2 Compatible with breastfeeding.
Peritoneal dialysis solution
intraperitoneal dialysis in Compatible with breastfeeding. solution of appropriate composition
Psychotherapeutic drugs
Drugs used in psychotic disorders
chlorpromazine :1 Avoid if possible. Monitor the infant for drowsiness.
fluphenazine a Avoid if possible. Monitor the infant for drowsiness.
haloperidol a Avoid if possible. Monitor the infant for drowsiness.
Recommendations for drugs in the Eighth WHO Model List of Essential Drugs
Drug Recommendation during lactation
24.
24.2
24.3
24.4
25.
25.1
Psychotherapeutic drugs (continued)
Drugs used in mood disorders
amitryptyline :3 Compatible with breastfeeding in doses up to 150 mg/day.
lithium carbonate a Avoid if possible. Monitor the infant for side-effects (restlessness or weakness). Monitor lithium levels in mother’s blood.
Drugs used in generalized anxiety disorders and for sedation
diazepam u Compatible with breastfeeding in single dose. Avoid repeated doses, if possible. Monitor the infant for drowsiness. Short-acting benzodiazepines preferred"
Drugs used for obsessive-compulsive disorders and for panic attacks
clomipramine r:r Compatible with breastfeeding.
Drugs acting on the respiratory tract
Antiasthmatic drugs
aminophylline 1: Compatible with breastfeeding. Monitor the infant for irritability.
beclometasone r:r Compatible with breastfeeding. cromoglicic acid :1 Compatible with breastfeeding. epinephrine in No data available. salbutamol a Compatible with breastfeeding.
* Suitable short—acting benzodiazepines include oxazepam and lorazepam. However, these are not included in the Model List of Essential Drugs.
lE
Breastfeeding and Maternal Medication
Drug Recommendation during lactation
25.2 Antitussives
codeine u Compatible with breastfeeding in single dose. Avoid repeated doses, if possible. Monitor the infant for side-effects (apnoea, bradycardia or cyanosis).
26. Solutions correcting water, electrolyte and acid-base disturbances
26.1 Oral rehydration
oral rehydration salts Compatible with breastfeeding. potassium chloride u Compatible with breastfeeding.
26.2 Parenteral
compound solution of sodium :i Compatible with breastfeeding. lactate
glucose :1 Compatible with breastfeeding. glucose with sodium chloride in Compatible with breastfeeding. potassium chloride :3 Compatible with breastfeeding. sodium chloride 1: Compatible with breastfeeding. sodium hydrogen carbonate :1 Compatible with breastfeeding.
26.3 Miscellaneous
water for injection :1 Compatible with breastfeeding.
Recommendations for drugs in the Eighth WHO Model List of Essential Drugs
Drug Recommendation during lactation
27. Vitamins and minerals
ascorbic acid :3 Compatible with breastfeeding in usual doses. If large doses are used, monitor for side- effects (haemolysis and jaundice), especially if the infant is premature.
calcium gluconate :2 Compatible with breastfeeding. ergocalciferol :1 Compatible with breastfeeding in doses used
as nutritional supplements. it pharmacological doses are required, monitor the calcium levels of the infant.
iodine :1 Compatible with breastfeeding in doses used as nutritional supplements and standard treatment of iodine deficient mothers.‘ Monitor the infant for side-effects (hypothyroidism).
nicotinamide :1 Compatible with breastfeeding. pyridoxine u Compatible with breastfeeding. retinol :1 Compatible with breastfeeding. riboflavin :3 Compatible with breastfeeding. sodium fluoride :1 Compatible with breastfeeding in doses used
as nutritional supplements. Long term, excessive exposure may cause mottling of teeth.
thiamine a Compatible with breastfeeding.
'See Section 15.1, page 21.
Breastfeeding and Maternal Medication
Recommendations for drugs in the Eighth WHO Model List of Essential Drugs
Alphabetical list of essential drugs
Drug Section Drug Section
A c
acetazolamide 21.4 calamine lotion 13.3 acetylsalicyclic acid 2.1, 7.1, 12.6 calcium iolinate 8.2 albendazole 6.1.1 calcium gluconate 27 albumin, human 11.2 calcium hypochlorite 15.2 alcuronium chloride 20 “Diopril 12.3 allopurinol 2.1 carbamazepine 5 aluminium diacetate 13.4 carbidopa + levodopa 9 aluminium hydroxide 17.1 charcoal, activated , 4.1 amidotrizoate 14.2 chloral hydrate 1.3 amiloride 16 choloramphenicol 6.2.2 p-aminobenzoic acid 13.7 chlorhexidine 15.1 aminophyiline 25.1 chlormethine (mustine) 8.2 amitriptyline 24.2 chloroquine 6.4.1, 6.4.3 amoxicillin 6.2.1 chlorphenamine 3 amphotericin B 6.3 chlorpromazlne 24.1 ampicillin 6.2.1 ciclosporin 8,1 anti-D immunoglobulin (human) 19.2 cimetidine 17.1 antihaemophilic fraction . 11.2 ciprotloxacin 6.2.2
(see Factor VIII concentrate) cisplatin 3,2 antihaemorrhoidal preparation: 17.3 clindamycin 6.2.2
local anaesthetic. astringent, clofazimine 6.2.3 and anti~inflammatory drug clomifene 18.6
antiscorpion sera 19.2 clomipramine 24.4 antitetanus immunoglobulin 19.2 cloxacillin 6.2.1
(human) coal tar 13.5 antivenom sera 19.2 codeine 2.2. 17.72, 25.2 ascorbic acid 27 colchicine 2.1 asparaginase 8.2 condoms 18.3.3 atenolol 12.1, 12.3 copper-containing intrauterine device 18.3.2 atropine 1.3, 4.2, 17.5. 21.5 cromoglicic acid 25.1 azathioprlne 8.1 cyclophosphamide 8.2
cytarabine 8.2
B D bacitracin + neomycin 13.2 barium sultate 14.2 dacarbazine 8.2 BCG vaccine (dried) 19.3.1 dactinomycin 8.2 beclometasone 25.1 dapsone 6.2.3 benzathine benzylpeniciliin 6.2.1 deteroxamine 4.2 benznidazole 6.4.4 0681710918885" 10.2 benzoic acid + salicylic acid 13.1 dexamethasone 3, 18.1 benzophenones 13.7 dextran 70 11.1 benzoyl peroxide 13.5 diaphraoms 18.3.3 benzyl benzoate 13.6 diazepam 1.3, 5, 24.3 benzylpeniciliin 6.2.1 diethylcarbamazine 6.1.2 betamethasone 13.3 diethyltoluamide 6.5 biperiden 9 digitoxin 12.4 bleomycin 8.2 digoxin 12.4 bupivacaine 1.2 diloxanide 6.4.1
IE
Breastfeeding and Maternal Medication
Drug Section Drug Section
dimercaprol 4.2 H diphtheria antitoxin 19.2 diphtheria-pertussis-tetanus vaccine 19.3.1 haloperidol 24.1 diphtheria-tetanus vaccine 19.3.1 halothane 1'1 dithranol 13.5 heparin 10.2 dopamine 12-5 hepatitis B vaccine 19.3.1 doxorubicin 8.2 hydralazine 123
“Well” 62-2 hydrochlorothiazide 12.3, 16 hydrocortisone 3, 13.3. 17.4, 18.1
E hydrogen peroxide 15.1 hydroxocobalamin 10.1
errnithine 6.4.4 epinephrine 3, 21.5, 25.1 | ergocalciferol 27 ergometrine 22.1 ibuprofen 2_1
ergotamine. 7‘1 idoxuridine 21.1 erythromycin 6-2-2 immunoglobulin, human normal 19.2 ethambutol 6.2.4 indometacin 2.1
ether, anaesthetic H influenza vaccine 19.3.2 ethinylestradiol ‘84 insulin inlection, soluble 18.5 ethinylestradiol + levonorgestrel 18.3.1 insulin, intermediate-acting 13,5 ethinylestradiol + norethisterone 18.3.1 infraperitoneal dialysis solution 23 ethosuximide 5 iodine 27
etoposide 3-2 iopanoic acid 14.2 iotroxate (see meglumine iotroxale) 14.2
F ipecacuanha 4.1 iron dextran 10.1
factor VIII concentrate 11.2 isoniazid 6.2.4 factor IX complex (coagulation 11.2 isoniazid + rifampicin 6.2.4
factors II. VII, IX, X concentrate) isoniazid + thioacetazone 6.2.4 ferrous salt 10.1 isoprenaline 12.2 ferrous salt + folic acid 10.1 isosorbide dinitrate 12.1 flucytosine 6.3 ivermectin 6.1.2 fludrocortisone 18.1 tluorescein 14.1 |( fluorouracil 8.2. 13.5 fluphenazine 24.1 ketamine 11
'0'“: 3°“ 10.1 ketoconazole 6.3 folic acid + ferrous salt 10.1 furosemide 16 L
G levamisole 6.1.1. 8.2 levodopa + carbidopa 9
gentamicin 6.2.2. 21.1 Ievonorgestrel + ethinylestradiol 18.3.1 gentian violet (see 13.2 levothyroxine 18.8
methylrosanilinium chloride) Iidocaine 1.2. 12.2 glucose 26.2 lithium carbonate 24.2 glucose with sodium chloride 26.2 glutaral. activated 15.2 M glyceryl trinitrate 12.1 griseotulvln 6.3 magnesium hydroxide 17.1
mannitol 16 measles-mumps-rubella vaccine 19.3.1
[E
Recommendations for drugs in the Eighth WHO Model List of Essential Drugs
Drug Section Drug Section
measles vaccine 19.3.1 permethrin 13.6 mebendazole 6.1.1 pethidine 2.2 medroxyprogesterone acetate (depot) 18.3.1, 18.7 phenobarbital 5 mefloquine 6.4.3 phenoxymethylpenicillin 6.2.1 meglumine antimoniate 6.4.2 phenytoin 5 meglumine iotroxate 14.2 phytomenadione 10.2 melarsoprol 6.4.4 pilomrpine 21.4 meningococcal vaccine 19.3.2 piperaciilin 6.2.1 mercaptopurine 82 piperazine 6.1.1 methionine 4.2 podophyllum resin 13.5 methotrexate 8.2 poliomyelitis vaccine 19.3.1 methyidopa ' 12.3 polygeline 11.1 methylene blue (see 4.2 potassium chloride 26.1
methylthioninium chloride) potassium ferric hexacyanoferrate (ii) 4.2 methylrosanilinium chloride (gentian violet) 13.2 zH20 (Prussian blue) methylthioninium chloride (methylene blue) 4.2 potassium iodide 18.8 metoclopramide 17.2 povidone iodine 15 metrilonate 6.1.3 praziquantel 6.1.1, 6.1.3 metronidazole 6.2.2, 6.4.1 prednisolone 3. 8.3, 18.1, 21.2 miconazole 13.1 primaquine 6.4.3 morphine 2.2 procaihamide 12.2
procaine benzylpenicillin 6.2.1 N procarbazine 8.2
proguanil 6.4.3 nalidixic acid 6.2.2 Promethazine 13' 17-2naloxone 4.2 propranolol 7.2, 12.1. 12.3 neomycin + bacltracin 13.2 DWWHWWE 14-2 neostigmine 20 propylthiouracil 18.8 niclosamide 6.1.1 protamine sulfate 10.2 nicotinamlde 27 Prussian blue (see potassium ferric 4.2 nifedipine 12.3 hexacyanoferrate (ll) 2H20 nifurtimox 6.4.4 Pyranfie' . 6-1-1 nitroturantoin 6.2.2 pyrazmamlde 5-2-4 nitrous oxide 1.1 pyridostipmine 2° nonoxinol 18.3.3 pyridoxine 27norethisterone 133.1. 13.7 pyrimethamine + sultadoxine 6.4.3 norethisterone enantate 18.3.1 norethisterone + ethinylestradiol 18.3.1 0 nystatin 6.3
quinidine 12.2 0 quinine 6.4.3
oral rehydration salts (for glucose- 17.7.1, 26.1 B electrolyte solution)
oxamniquine 6.1.3 rabies immunoglobulin 19.2 oxygen 1.1 rabies vaccine 19.3.2 oxytocin 22.1 reserpine 12.3
retinol 27 P riboflavin 27
rifampicin 6.2.4
penicillamine 42 rubella Vaccine 19.3.2
pentamidine 6.4.2, 6.4.4
Breastfeeding and Maternal Medication
Drug Section Drug Section
S tetanus vaccine 19.3.1 tetracaine 21.3
salbutamol 22.2, 25.1 tetracycline 6.2.2, 6.4.3, 21.1
salicylic acid 13.5 thiamine . _ , 27 salicylic acid + benzoic acid 13.1 thloacetazone + 'Son'az'd 614 selenium sulfide 13.1 WWWW 1-1 senna 176 timolol 21.4
silver nitrate 21.1 tolbutamide 18-5 silver sultadiazine 13.2 trimelhODrim 6-2-2 sodium bicarbonate (see sodium 262 tnme'hognm + Sulfamethoxazme 6.2.2
hydrogen carbonate) tropicamlde 14.1
sodium calcium edetate 4‘2 tuberculin. purified protein derivate (PPD) 19.1
sodium chloride 26.2 WWW “Wine 19-3-2 sodium chloride with glucose 26.2 sodium fluoride 27 V sodium hydrogen carbonate 26.2 sodium lactate, compound solution 26.2 valproic acid 5 sodium nitrite 4.2 vecuronium bromide 20 sodium nitroprusside 12.3 verapamil 12.2 sodium thiosultate 4.2. 13.1 vinblastine 8.2 spectinomycin 6.2.2 vincristine 8.2 spironolactone 16 streptokinase 12.6 w streptomycin 6.2.4
sultadoxme + pyrimethamine 6.4.3 water for injection 253 sulfamethoxazole + trimethoprim 6.2.2 sulfasalazine 17.4 Y suramln sodium 6.1.2, 6.4.4
suxamethonium 20 yellow fever vaccine 19.3.2
T 2 tamoxifen 8.3 . . testosterone 18.2 zlnc Ode 13'7