Drugs and their categories in pregnancy and breastfeeding-D

Drug	Pregnancy category	Compatibility with breastfeeding
dalteparin	C	compatible
danazol	D	avoid, reduced milk supply
dantrolene	B2	avoid, insufficient data
dapsone	B2	caution, monitor for haemolysis, avoid in G6PD-deficient infants
delavirdine	B3	insufficient data [Note 1]
desferrioxamine	B3	caution, insufficient data. Bioavailability in infant expected to be low
desmopressin	B2	compatible
desogestrel	B3	avoid, oestrogen in combination may reduce milk supply
desonide	B3	compatible
dexamethasone	A	compatible
dexamphetamine	B3	insufficient data
dexchlorpheniramine	A	compatible; monitor infant for irritability and sleep disturbances
dextropropoxyphene	C	compatible
diazepam	C	compatible in single doses, caution with chronic use; if used in latter situation, monitor infant for drowsiness
diazoxide	C	avoid, insufficient data
diclofenac	C	compatible [Note 10]
dicloxacillin	B2	compatible; may cause diarrhoea in infant
dicobalt edetate	unlisted	caution, insufficient data
didanosine	B2	insufficient data [Note 1]
diethylpropion	B2	avoid
diflunisal	C	caution [Note 10]
digoxin	A	compatible
digoxin immune Fab	B2	caution, insufficient data [Note 12]
dihydroergotamine	C	avoid
diloxanide furoate	unlisted	insufficient data
diltiazem	C	compatible
dimenhydrinate	A	caution, observe infant for sedation
diphemanil methylsulfate	unlisted	caution, insufficient data
diphenhydramine	A	compatible; monitor infant for irritability and sleep disturbances
diphenoxylate+atropine	C	compatible; monitor the infant for anticholinergic effects
dipyridamole	B1	avoid, insufficient data
disodium pamidronate	B3	caution, insufficient data
disopyramide	B2	compatible
disulfiram	B2	insufficient data
dithranol	unlisted	caution, insufficient data
dobutamine	B2	caution, insufficient data
docusate	A	compatible
dolasetron	B1	caution, insufficient data
domperidone	B2	compatible
donepezil	B3	insufficient data
dopamine	B3	caution, insufficient data
dornase alfa	B1	compatible
dothiepin	C [Note 6]	compatible
doxepin	C [Note 6]	caution, others preferred
doxycycline	D [Note 4]	compatible for short courses (7 to 10 days) if alternative drug not appropriate; may cause diarrhoea in infant
doxylamine	A	compatible; monitor infant for irritability and sleep disturbances
droperidol	C	compatible at lower dose (less than 10 mg daily)
drospirenone	B3	avoid, oestrogen in combination may reduce milk supply
dydrogesterone	D	avoid, insufficient data

Note 1: In Australia, breastfeeding is not recommended for HIV-positive women because of the possibility of HIV transmission. Note 2: Human data are inadequate and the safety of these medications in pregnancy is uncertain. Note 3: Antiandrogens have the potential to feminise the male fetus, avoid in pregnancy. Note 4: Tetracyclines are safe for use during the first 18 weeks of pregnancy (16 weeks postconception) after which they may affect the formation of the baby's teeth and cause discolouration. Note 6: Tricyclic antidepressants have been taken by a large number of pregnant women without any proven increase in the frequency of fetal malformation. In full-term neonates, reversible adverse effects have occasionally been observed, but very rarely cause significant problems. Note 7: Although theophylline has a Category A rating, it does cross the placental barrier. The effect on fetal development is not known. Theophylline clearance is significantly decreased in premature infants. Therefore, if this drug is administered to the mother near the time of delivery, the neonate should be monitored closely for the pharmacological effects of theophylline. Hence the use of theophylline in pregnant women should be balanced against the risk of uncontrolled asthma. Note 8: See also: Cleland LG, James MJ, Proudman SM. Fish oil: what the prescriber needs to know. Arthritis Research and Therapy 2006;8(1):202-11. Note 9: See leflunomide regarding preconception advice and cholestyramine washout. Note 10: If an NSAID is required in a breastfeeding patient, diclofenac or ibuprofen is preferred. Note 11: Absorption of eye drops into the maternal circulation is generally low, although there are occasional reports of systemic effects. Nevertheless, significant transfer into milk is unlikely. Note 12: Large molecular weight proteins/polypeptides are unlikely to transfer into milk. In the absence of specific information, adverse effects in the infant are unlikely. Note 13: Early reports of pregnancy outcomes in women treated with beta blockers in pregnancy, particularly dealing with propranolol, described a relatively high incidence of fetal growth restriction. This appears to be the basis for the C classification of the class of drugs. Since these findings were not from randomised studies, but were clinical descriptions of women who had underlying disorders known to be associated with an increased rate of both intrauterine fetal growth restriction and death, it is not possible to determine whether the described outcomes were due to the therapy or to the disorder for which therapy was prescribed. Subsequent evidence has indicated fetal growth restriction in hypertensive pregnant women treated with atenolol, but better fetal growth in women treated with another beta blocker, oxprenolol, than in women treated with methyldopa. This has been attributed to the intrinsic sympathomimetic activity inherent in this drug. No other fetal or neonatal problems have been attributed to beta-blocker therapy in pregnancy, and they are widely prescribed for the treatment of hypertension in this situation.