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TABLE 4 Drugs for Which the Effect on Nursing Infants Is Unknown but May Be of Concern* Drug Reported or Possible Effect Reference No. Anti-anxiety   Alprazolam None 57    Diazepam None 58-62   Lorazepam None 63    Midazolam 64    Perphenazine None 65    Prazepam None 66    Quazepam None 67    Temazepam 68  Antidepressants   Amitriptyline None 69, 70   Amoxapine None 71    Bupropion None 72    Clomipramine None 73    Desipramine None 74, 75   Dothiepin None 76, 77   Doxepin None 78    Fluoxetine Colic, irritability, feeding and sleep disorders, slow weight gain 79-87   Fluvoxamine 88    Imipramine None 74    Nortriptyline None 89, 90   Paroxetine None 91    Sertraline None 92, 93   Trazodone None 94  Antipsychotic   Chlorpromazine Galactorrhea in mother; drowsiness and lethargy in infant; decline in developmental scores 95-98   Chlorprothixene None 99    Clozapine None 100   Haloperidol Decline in developmental scores 101-104   Mesoridazine None 105   Trifluoperazine None 104 OTHERS Amiodarone Possible hypothyroidism 106 Chloramphenicol Possible idiosyncratic bone marrow suppression 107, 108 Clofazimine Potential for transfer of high percentage of maternal dose; possible increase in skin pigmentation 109 Lamotrigine Potential therapeutic serum concentrations in infant 110 Metoclopramide None described; dopaminergic blocking agent 111, 112 Metronidazole In vitro mutagen; may discontinue breastfeeding for 12-24 h to allow excretion of dose when single-dose therapy given to mother 113, 114 Tinidazole See metronidazole 115 * Psychotropic drugs, the compounds listed under anti-anxiety, antidepressant, and antipsychotic categories, are of special concern when given to nursing mothers for long periods. Although there are very few case reports of adverse effects in breastfeeding infants, these drugs do appear in human milk and, thus, could conceivably alter short-term and long-term central nervous system function.56 See discussion in text of psychotropic drugs. Drug is concentrated in human milk relative to simultaneous maternal plasma concentrations.

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