Cautions breast-feeding

As with other quinolones, ciprofloxacin should be used with caution in epileptic patients (since it may precipitate seizures), in children, during pregnancy and breast-feeding (due to risk of arthropathy in weight-bearing joints). 

Lactation It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, exercise caution when tigecycline is administered to a breast-feeding woman. 

Deravirdine (Rescnptor) [Antiretroviral/NNRTI] Uses HIV Infxn Action Nonnucleoside RT inhibitor Dose 400 mg PO tid Caution [C, ] CDC recommends HIV-infected mothers not to breast-feed (transmission risk) w/ renal/hepatic impair Contra Use w/ drugs dependent on CYP3A for clearance (Table VI-8) Disp Tabs SE Fat redistribution, immune reconstitution synd, HA, fatigue, rash, T transaminases, N/V/D Interactions T Effects W/ fluoxetine T effects OF benzodiazepines, cisapride, clarithromycin, dapsone, ergotamine, indinavir, lovastatin, midazolam, nifedipine, quinidine, ritonavir, simvastatin, terfena-dine, triazolam, warfarin effects W/ antacids, barbiturates, carbamazepine, cimetidine, famotidine, lansoprazole, nizatidine, phenobarbital, phenytoin, ranitidine, rifabutin, rifampin effects OF didanosine EMS Use of benzodiazepines and CCBs should be avoided may cause a widespread rash located on upper body and arms OD May cause an extension of nl SEs symptomatic and supportive Deferasirox (Exjade) [Iron Chelator] Uses Chronic iron overload d/t transfusion in pts >2 y Action Oral iron chelator Dose Initial 20 mg/kg... 

Efavirenz (Sustiva) [Antiretroviral/NNRTI] Uses Hiv infxns Action Antiretroviral nonnucleoside RTI Dose Adults. 600 mg/d PO qhs Feds. See package insert avoid high-fat meals Caution [D, ] CDC recommends HIV-infected mothers not breast-feed Contra Component sensitivity Disp Caps SE Somnolence, vivid dreams, dizziness, rash, N/V/D Interactions T Effects W/ ritonavir T effects OF CNS depressants, ergot derivatives, midazolam, ritonavir, simvastatin, triazolam, warfarin X effects W/ carbamazepine, phenobarbital, rifabutin, rifampin, saquinavir, St. John s wort i effects OF amprenavir, carbamazepine, clarithromycin, indinavir, phenobarbital, saquinavir, warfarin may alter effectiveness OF OCPs EMS Concurrent EtOH usage can t CNS d ression OD May cause muscle contractions and adverse CNS effects activated charcoal may be effective... 

Methimazole (Tapazole) [Antithyroid Agent] Uses Hyperthy-roidism, thyrotoxicosis, pr for thyroid surgery or radiation Action Blocks T3 T4 formation Dose Adults. Initial 15-60 mg/d PO tid Maint 5-15 mg PO daily Peds. Initial 0.4-0.7 mg/kg/24 h PO tid Maint V h- U h of initial dose PO daily w/ food Caution [D, +/-] Contra Breast-feeding Disp Tabs SE GI upset, dizziness, blood dyscrasias Interactions t Effects OF digitalis glycosides, metoprolol, propranolol X effects OF anticoagulants, theophylline X effects W/ amiodarone EMS None OD May cause N/V, HA, abd pain, fever, and pale skin symptomatic and supportive... 

Rimantadine (Flumadine) [Antiviral] Uses Prophylaxis Rx of influenza A viral Infxns but not for HlNl swine flu Action Antiviral Dose Adults Feds >9 y. 100 mg PO bid Feds 2-9 y. 5 mg/kg/d PO, 150 mg/d max daily w/ severe renal/hepatic impair elderly initiate w/in 48 h of Sx onset Caution [C, -] w/ cimetidine avoid w/ PRG, breast-feeding Contra Component amantadine allergy Disp Tabs SE Orthostatic X BP, edema, dizziness, GI upset, X Sz threshold Interactions T Effects W/ cimetidine i effects W/ acetaminophen, ASA EMS Concurrent EtOH usage may result in light-headedness, confusion, syncope, and hypotension OD May cause N/V, tremors, Szs, anticholinergic Sxs, ventricular arrhythmias give IV fluids... 

Drugs that are not absorbed from the gastrointestinal tract of the baby, such as warfarin, are safe for the mother to take. The administration of antibiotics to a breast-feeding mother usually poses no concern for the newborn infant. However, metronidazole, which has mutagenic properties, reaches concentrations in milk that equal or exceed maternal plasma levels. Caution is also advised with sulphonamides, nitrofurantoin, or naladixic acid since these can cause haemolysis in infants with glucose-6-phosphate dehydrogenase deficiency. 

Both thioamides cross the placental barrier and are concentrated by the fetal thyroid, so that caution must be employed when using these drugs in pregnancy. Of the two, propylthiouracil is preferable in pregnancy because it is more strongly protein-bound and therefore crosses the placenta less readily. In addition, it is not secreted in sufficient quantity in breast milk to preclude breast-feeding. 

Lithium Significant Breast-feeding with caution levels can be measured in milk. 

Barbiturates are also present in high concentrations in the breast milk of women who take them. Infants who consume this breast milk may experience side effects like excess sleepiness and lethargy. They may also experience withdrawal symptoms when weaned from breast milk. Long-term adverse effects of infant exposure to barbiturates in breast milk have not been well documented. However, the American Academy of Pediatrics cautions against breast-feeding while taking barbiturates because there may be risks to the infant. 

Contraindications for homatropine are essentially the same as for atropine. As with atropine, very small amounts of homatropine have been detected in breast milk. According to the American Academy of Pediatrics, however, homatropine use is compatible with breast-feeding, but caution should be exercised when administering homatropine to nursing women. As with topical administration of atropine, homatropine can also induce CNS toxicity in the elderly. 

In patients with reduced respiratory reserve, such as those with emphysema, severe obesity, cor pulmonale, and kyphoscoliosis, opioids must be used with caution. The relative benefits and harms of using opioids in patients taking monoamine oxidase inhibitors, those with a history of drug abuse, asthma, hepatic impairment, hypotension, raised intracranial pressure, or head injury, and during pregnancy or breast feeding, should be carefully considered. Dextropropoxyphene, pethidine, and methadone should be used with caution (SEDA-21, 85). 

Great stress, to ensure efficacy, is put on those products containing stimulants, such as caffeine or ephedra, to those on a diet, workout often, or under the age of 18. These products can cause long-term stress to the body if used for extensive amounts of time. Ephedra arises in the concern of the FDA because of the mechanism of ephedra in the human body. The adrenaline-like stimulant can cause dangerous effects to the nervous system and heart. Some of these effects include heart attack, seizure, stroke, and even death. There must be caution because the risk can increase with the dose, and with strenuous exercise. It specifies certain groups (such as women who are pregnant or breast feeding) who should never use these products and lists other conditions, such as diseases and the use of certain medications that rule out the use of ephedrine alkaloids. 

A recent review by the Cochrane Library indicated that existing randomized, controlled trials are insufficient to establish an effect of hormonal contraception, if any, on milk quality and quantity. Furthermore, the review stated that current recommendations are for breast-feeding women to avoid combined OCs in the first 6 weeks postpartum and to use them with caution in the 6-month postpartum period. ... 

---