Drugs and their categories in pregnancy and breastfeeding-P

Drug	Pregnancy category	Compatibility with breastfeeding
palifermin	B3	caution, insufficient data
pamidronate disodium	B3	caution, insufficient data
pancuronium	B2	caution, insufficient data
pantoprazole	B3	compatible
paracetamol	A	compatible
paracetamol+codeine	A	compatible+compatible in occasional doses; avoid repeated doses
paraffin liquid	B2	compatible
parecoxib	C	caution, insufficient data
paromomycin	unlisted	avoid, insufficient data
paroxetine	D [Note 2]	probably compatible
peginterferon alfa-2a	B3	caution, insufficient data
peginterferon alfa-2b	B3	caution, insufficient data
penicillamine	D	avoid, insufficient data
pentamidine	B3	avoid, insufficient data
pergolide	C	avoid, insufficient data
perhexiline	B2	avoid, insufficient data
pericyazine	C	compatible at lower dose (less than 50 mg daily)
perindopril	D	avoid, insufficient data
permethrin	B2	compatible
pethidine	C	compatible in occasional doses
phenelzine	B3	insufficient data
pheniramine	A	compatible; monitor infant for irritability and sleep disturbances
phenobarbitone	D	avoid, may cause sedation
phenolphthalein	B2	avoid if possible, insufficient data, monitor the infant for changes in stool consistency
phenoxybenzamine	B2	avoid, insufficient data
phenoxymethylpenicillin	A	compatible; may cause diarrhoea in infant
phentermine	B3	avoid
phentolamine	B1	caution, insufficient data
phenytoin	D	compatible
pholcodine	A	compatible
physostigmine	C	caution, insufficient data
phytomenadione	unlisted	compatible
pilocarpine	unlisted	caution, insufficient data [Note 11]
pimecrolimus	B3	caution, insufficient data, avoid use on breasts
pimozide	B1	compatible at lower dose (less than 10 mg daily)
pioglitazone	B3	avoid, insufficient data
piperacillin	B1	compatible; may cause diarrhoea in infant
piperacillin+tazobactam	B1	compatible; may cause diarrhoea in infant
piperazine oestrone sulfate	B1	avoid, reduced milk supply
piperonyl butoxide	B3	compatible
piracetam	unlisted	avoid, insufficient data
piroxicam	C	compatible [Note 10]
pizotifen	B1	avoid, insufficient data
podophyllotoxin	D (do not use)	avoid
podophyllum	unlisted (do not use)	avoid
poloxalkol	A	compatible
polyethylene glycol	unlisted	compatible
potassium chloride	unlisted	compatible
potassium permanganate	unlisted	compatible
povidone-iodine	unlisted (not recommended)	avoid, could interfere with infant thyroid function
pralidoxime	unlisted	caution, insufficient data
pravastatin	D	avoid, insufficient data
praziquantel	B1	compatible
prazosin	B2	avoid, insufficient data
prednisolone	A	compatible
prednisone	A	compatible
pregabalin	B3	avoid, insufficient data
prilocaine	A	compatible
prilocaine with adrenaline	A	compatible
prilocaine with felypressin	A	compatible
primaquine	D	compatible
primidone	D	compatible
probenecid	B2	caution, insufficient data
probucol	B1	avoid, insufficient data
procaine	B2	compatible
procaine penicillin	A	compatible
prochlorperazine	C	caution, observe infant for adverse effects
proguanil	B2	compatible
promethazine	C	compatible, monitor infant for irritability and sleep disturbance
propantheline	B2	caution, observe infant for adverse effects
propofol	C	compatible
propranolol	C [Note 13]	compatible
propylthiouracil	C	compatible
Prothrombinex-VF	C	caution, insufficient data [Note 12]
proxymetacaine	B2	caution, insufficient data [Note 11]
pseudoephedrine hydrochloride	B2	caution, reduces milk supply
psyllium	unlisted	compatible
pyrantel	B2	compatible
pyrazinamide	B2	caution, insufficient data
pyrethrins	B2	compatible
pyridostigmine	C	compatible
pyridoxine	unlisted	compatible in therapeutic doses
pyrimethamine	B3	compatible

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.