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As you are about to step out of a newly delivered mother™s room, she mentions that she wants to breast-feed her healthy infant, but that her obstetrician was concerned about one of the medicines she was taking. Which of the woman™s medicines, listed below, is clearly contraindicated in breast-feeding?
Options:
1. Ibuprofen as needed for pain or fever
2. Labetolol for her chronic hypertension
3. Lithium for her bipolar disorder
4. Carbamazepine for her seizure disorder
5. Acyclovir for her HSV outbreak
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2. Labetolol for her chronic hypertension
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Answer is: Lithium for her bipolar disorder
Most medications are secreted to some extent in breast milk. Some lipid-soluble medications may be concentrated in breast milk. Although the list of contraindicated medications is short, caution should always be exercised when giving a medication to a breast-feeding woman. Medications that are clearly contraindicated include lithium, cyclosporin, antineoplastic agents, illicit drugs including cocaine and heroin, ergotamines, and bromocriptine (which supresses lactation). Although some suggest that oral contraceptives may have a negative impact on milk production, the association has not been proven conclusively. In general, antibiotics are safe, with only a few exceptions. While sedatives and narcotic pain medications are probably safe, the infant must be observed carefully for sedation. All of the medications listed in the question are considered safe, except for lithium.
