Key medication considerations
during pregnancy and  breast-feeding.

AGENT

FDA  PR*

CATEGORY

SAFE DURING PREGNANCY?

SAFE DURING BREAST-FEEDING?

Analgesics and Anti-inflammatories†

B C/D C

C C C/D B

Yes

Avoid

Use  with caution

Avoid‡

Use  with caution
Avoid use in third
trimester Use  with caution

Yes
Avoid
Yes Yes

Use  with caution

Yes

Use  with caution

Antibiotics¶# Amoxicillin
Azithromycin
Cephalexin
Chlorhexidine (topical)
Clarithromycin Clindamycin Clotrimazole (topical) Doxycycline Erythromycin

B B B B C B B D B

C/D B

C B B D

Yes Yes Yes Yes

Use  with caution

Yes
Yes Avoid
Yes

Yes (single-dose regimens)
Yes

Yes
Yes Yes Avoid

Yes Yes Yes Yes

Use  with caution

Yes
Yes Avoid

Use  with caution

Yes

Avoid; may give breast
milk an unpleasant taste
Yes

Yes
Yes Avoid

Local Anesthetics
Articaine
Bupivacaine

C C B C B C C B C

Use  with caution Use  with caution Yes

Use  with caution

Yes

Use  with caution

Yes

Yes

Use  with caution

Use  with caution

Yes Yes Yes Yes

Use  with caution

Yes

Yes

Use  with caution

Sedatives Benzodiazepines
Zaleplon
Zolpidem

D/X C

C

Avoid

Use  with caution

Use  with caution

Avoid

Use  with caution

Yes

Emergency Medications

C B

C C C C

Steroid and β2-agonist inhalers are safe

Yes

Use  with caution Use
with caution Use
with caution Use
with caution

Yes

Avoid

Yes

Use  with caution Use
with caution Use
with caution

*
FDA PR: U.S. Food and Drug Administration Pregnancy Risk. See Table 1
for FDA PR category definitions.

† In the case of combination products (such as oxycodone with
acetaminophen), the safety with  respect to either pregnancy or breast-feeding is dependent
on the highest-risk moiety. In the example
of oxycodone with  acetaminophen, the combination of these
two drugs should  be used with  caution, because the oxycodone moiety carries a higher risk
than the acetaminophen moiety.

‡ Oral steroids should not be withheld from patients with  acute severe asthma.

§ Ibuprofen is representative
of all nonsteroidal anti-inflammatory drugs. In breast-feeding patients, avoid
cyclooxygenase selective inhibitors such as celecoxib, as few data regarding their  safe
use in this
population  are
available, and avoid
doses of aspirin  higher than

100 milligrams because of risk
of platelet  dysfunction
and Reye
syndrome.

¶ Antibiotic
use during  pregnancy: The patient should
receive the full adult dose and for the usual length
of treatment. Serious infections should be treated aggressively. Penicillins and cephalosporins are considered safe.
Use higher-dose
regimens (such as cephalexin 500 mg three times
per day rather  than
250 mg three times
per day), as they are cleared from the system more quickly  because of the increase

in glomerular filtration rate in pregnancy.

# Antibiotic
use during  breast-feeding: These
agents may cause altered bowel flora and, thus, diarrhea  in the baby. If the infant develops a fever, the clinician should take into account
maternal antibiotic treatment.