Cover 
1 
Drugs During Pregnancy and Lactation 4
Copyright 5
Contents 6
List of Contributors 20
Preface 24
Disclaimer 26
1 - General commentary on drug therapy and drug risks in ­pregnancy 28
1.1 Introduction 28
1.2 Development and health 29
1.3 Reproductive stages 30
1.4 Reproductive and developmental toxicology 31
1.5 Basic principles of drug-induced reproductive and developmental toxicology 35
1.6 Effects and manifestations 37
1.7 Pharmacokinetics of drugs in pregnancy 38
1.8 Mechanisms of developmental toxic agents 40
1.9 Causes of developmental disorders 41
1.10 Embryo/fetotoxic risk assessment and plausibility 42
1.11 Classification of drugs used in pregnancy 44
1.12 Paternal use of medicinal products 45
1.13 Communicating the risk of drug use in pregnancy 46
1.14 Risk communication prior to pharmacotherapeutic choice 47
1.15 Risk communication regarding the safety of drugs already used in pregnancy 48
1.16 Teratology information centers 48
References 49
2 - Specific drug therapies 
52 
2.1 - Analgesics, non-steroidal anti-­inflammatory drugs (NSAIDs), muscle relaxants, and antigout medications 54
2.1.1 Paracetamol (acetaminophen) 54
2.1.2 Acetylsalicylic acid 56
2.1.3 Pyrazolone compounds and phenylbutazone 59
2.1.4 Analgesic drug combination products and drugs used for osteoarthritis 60
2.1.5 Opioid agonists and antagonists and other centrally acting analgesics 61
2.1.6 Non-steroidal anti-inflammatory and antirheumatic drugs 68
2.1.7 Migraine therapy 73
2.1.8 Muscle relaxants and other analgesics 75
2.1.9 Antigout preparations 76
References 78
2.2 - Allergy and hyposensitization therapy 86
2.2.1 Antihistamines (H1-blocker) 86
2.2.2 Hyposensitization therapy 88
2.2.3 C1-Esterase inhibitor deficiency 88
References 89
2.3 - Antiasthmatic and cough ­medication 92
2.3.1 Selective ß2-adrenergic agonists 93
2.3.2 Inhaled corticosteroids (ICSs) 94
2.3.3 Theophylline 95
2.3.4 Leukotriene antagonists 96
2.3.5 Mast cell stabilizers (inhibitors) 96
2.3.6 Anticholinergics 97
2.3.7 Omalizumab and roflumilast 97
2.3.8 Expectorants and mucolytic agents 97
2.3.9 Antitussives 98
2.3.10 Non-selective ß-adrenergic agonists 99
References 100
2.4 - Nausea and vomiting in pregnancy 102
2.4.1 Treatment options 103
2.4.2 Complementary treatment options 103
2.4.3 Pharmacological treatment options 105
2.4.4 Dopamine antagonists 108
2.4.5 Pyridoxine (vitamin B6) 110
2.4.6 Vitamin B1 111
2.4.7 Serotonin antagonists 112
2.4.8 Glucocorticoids 113
2.4.9 Other antiemetics 113
Summary 114
References 114
2.5 - Gastro-intestinal medications, hypolipidemic agents and ­spasmolytics 120
2.5.1 Antacids 121
2.5.2 Sucralfate and pirenzepine 122
2.5.3 H2 receptor antagonists 122
2.5.4 Proton pump inhibitors 123
2.5.5 Bismuth salts 124
2.5.6 Helicobacter pylori therapy 124
2.5.7 Digestives and carminatives 125
2.5.8 Atropine and other anticholinergic spasmolytics 125
2.5.9 Cholinergics 126
2.5.10 Constipation during pregnancy 126
2.5.11 Antidiarrheal agents 129
2.5.12 Medications for inflammatory bowel disease 130
2.5.13 Chenodeoxycholic acid and ursodeoxycholic acid 131
2.5.14 Lipid lowering agents 132
2.5.15 Appetite suppressants, weight loss medications, and obesity 135
References 136
2.6 - Anti-infective Agents 142
2.6.1 Penicillins and ß-lactamase inhibitors 143
2.6.2 Cephalosporins 144
2.6.3 Carbapenems and monobactams 144
2.6.4 Erythromycin and other macrolides 145
2.6.5 Clindamycin and lincomycin 146
2.6.6 Tetracyclines 147
2.6.7 Sulfonamides and trimethoprim 148
2.6.8 Quinolones 149
2.6.9 Nitrofurans and drugs for urinary tract infections 150
2.6.10 Nitroimidazole antibiotics 152
2.6.11 Aminoglycosides 152
2.6.12 Glycopeptide and polypeptide antibiotics 153
2.6.13 Other antibiotics 154
2.6.14 Tuberculosis and pregnancy 156
2.6.15 Local antibiotics 159
2.6.16 Malaria prophylaxis and treatment in pregnancy 159
2.6.17 Azole antifungals 166
2.6.18 Amphotericin B 168
2.6.19 Echinocandins 168
2.6.20 Flucytosine 169
2.6.21 Griseofulvin 169
2.6.22 Terbinafine 170
2.6.23 Topical antifungal agents 170
2.6.24 Anthelmintics 171
2.6.25 Herpes medications 174
2.6.26 Antiviral drugs for hepatitis 175
2.6.27 Antiviral drugs for influenza 177
2.6.28 Antiretroviral agents 178
2.6.29 Overview of the antiretroviral medications 179
2.6.30 Nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs) 180
2.6.31 Non-nucleoside reverse transcriptase inhibitors (NNRTIs) 182
2.6.32 Protease inhibitors (PIs) 184
2.6.33 Entry inhibitors 187
2.6.34 Integrase inhibitors 188
2.6.35 Hyperthermia 189
2.6.36 Long-distance travel and flights 189
References 190
2.7 - Vaccines and immunoglobulins 204
2.7.1 Thiomersal as a preservative for vaccines 205
2.7.2 Cholera vaccination 206
2.7.3 Diphtheria and tetanus vaccination 206
2.7.4 Haemophilus influenza B (HIB) vaccination 207
2.7.5 Hepatitis A and hepatitis B vaccination 207
2.7.6 HPV vaccination 207
2.7.7 Influenza vaccination 208
2.7.8 Measles and mumps vaccination 210
2.7.9 Meningococcal vaccination 210
2.7.10 Pertussis vaccination 211
2.7.11 Pneumococcal vaccination 211
2.7.12 Poliomyelitis vaccination 211
2.7.13 Rabies vaccination 212
2.7.14 Rubella vaccination 212
2.7.15 Tick-borne encephalitis vaccination 213
2.7.16 Typhoid vaccination 213
2.7.17 Varicella vaccination 214
2.7.18 Yellow fever vaccination 214
2.7.19 Immunoglobulins 215
References 216
2.8 - Heart and blood medications 220
2.8.1 Arterial hypertension and pregnancy 221
2.8.2 a-Methyldopa 222
2.8.3 ß-Receptor blockers 223
2.8.4 Calcium channel blockers 225
2.8.5 ACE inhibitors 226
2.8.6 Angiotensin II receptor blockers (ARBs Sartans)
2.8.7 Dihydralazine 229
2.8.8 a-1 Blockers (peripherally acting adrenergic antagonists) 229
2.8.9 a-2 Blockers (centrally acting adrenergic antagonists) 230
2.8.10 Other antihypertensive medications 231
2.8.11 Pulmonary hypertension and pregnancy 232
2.8.12 Hypotension and antihypotensive drugs 234
2.8.13 Adrenergic agents 235
2.8.14 Cardiac glycosides 235
2.8.15 Antiarrhythmic medications 235
2.8.16 Coronary therapeutic drugs (cardiac vasodilators) 240
2.8.17 Vasocirculatory drugs and peripheral vasodilators 241
2.8.18 Diuretics 242
References 244
2.9 - Anticoagulants, thrombocyte aggregation inhibitors, fibrinolytics and volume replacement agents 252
2.9.1 Indications for anticoagulation 253
2.9.2 Heparins and danaparoid 254
2.9.3 Protamines 256
2.9.5 Factor Xa inhibitors 258
2.9.6 Inhibitors of thrombocyte aggregation 258
2.9.7 Vitamin K antagonists 260
2.9.8 Vitamin K 264
2.9.9 Fibrinolysis 265
2.9.10 Streptokinase 266
2.9.11 Antihemorrhagics 266
2.9.12 Other antihemorrhagics 267
2.9.13 Volume replacement substances and rheologics 268
References 269
2.10 - Epilepsy and antiepileptic medications 278
2.10.1 Antiepileptic therapy 279
2.10.2 Antiepileptic and contraceptive drugs 280
2.10.3 Epilepsy and fertility 280
2.10.4 Frequency of seizures in pregnancy 281
2.10.5 Risk of malformations 281
2.10.6 Typical malformations and other anomalies 283
2.10.7 Pregnancy complications 283
2.10.8 Mental development dysfunction 284
2.10.9 “Damage mechanisms” 285
2.10.10 Folic acid and antiepileptic drugs 286
2.10.11 Vitamin K and antiepileptic drugs 286
2.10.12 Is epilepsy teratogenic? 287
2.10.13 Carbamazepine 287
2.10.14 Clobazam and clonazepam 290
2.10.15 Eslicarbazepine 291
2.10.16 Ethosuximide and other succinimides 291
2.10.17 Felbamate 292
2.10.18 Gabapentin 292
2.10.19 Lacosamide 293
2.10.20 Lamotrigine 294
2.10.21 Levetiracetam 295
2.10.22 Oxcarbazepine 296
2.10.23 Phenobarbital and primidone 297
2.10.24 Phenytoin 300
2.10.25 Pregabalin 301
2.10.26 Rufinamide 302
2.10.27 Sultiame 302
2.10.28 Tiagabine 302
2.10.29 Topiramate 303
2.10.30 Valnoctamide 304
2.10.31 Valproic acid 305
2.10.32 Vigabatrin 309
2.10.33 Zonisamide 310
References 311
2.11 - Psychotropic drugs 320
2.11.1 Psychiatric disorder during pregnancy 321
2.11.2 Antidepressant treatment 321
2.11.3 Selective serotonin-reuptake-inhibitors (SSRI) 322
2.11.4 Tri- and tetracyclic antidepressants 329
2.11.5 Individual antidepressants 330
2.11.6 Antipsychotic treatment 340
2.11.7 Individual antipsychotic drugs 343
2.11.8 Lithium and other anti-manic agents 349
2.11.9 Anxiolytics, hypnotics, sedatives in general 351
2.11.10 Benzodiazepines 352
2.11.11 Zaleplon, zolpidem and zopiclone 354
2.11.12 Other anxiolytics and hypnotics 355
2.11.13 Psychoanaleptics 355
2.11.14 Anti-Parkinson drugs and restless legs syndrome 356
References 357
2.12 - Immunosuppression, rheumatic diseases, multiple ­sclerosis, and Wilson’s disease 368
2.12.1 Azathioprine/6-mercaptopurine 368
2.12.2 Selective immunosuppressants 369
2.12.3 Biologics 372
2.12.4 Multiple sclerosis 379
2.12.5 Interferons 381
2.12.6 Other immunostimulatory drugs 383
2.12.7 Transplantation 385
2.12.8 Drugs for rheumatic diseases 385
2.12.9 Drugs for Wilson’s disease 390
References 392
2.13 - Antineoplastic drugs 400
2.13.1 Malignancy and pregnancy 401
2.13.2 Breast cancer 403
2.13.3 Vinca alkaloids and analogs 404
2.13.4 Podophyllotoxin derivatives 404
2.13.5 Nitrosourea alkylators 405
2.13.6 Nitrogen mustard analog alkylators 405
2.13.7 Other alkylating agents 406
2.13.8 Cytotoxic anthracycline antibiotics 407
2.13.9 Other cytotoxic antibiotics 408
2.13.10 Folate antagonists 409
2.13.11 Purine antagonists 410
2.13.12 Pyrimidine antagonists 410
2.13.13 Taxanes and other cytostatic agents 412
2.13.14 Monoclonal antibodies 412
2.13.15 Platin compounds 413
2.13.16 Thalidomide and its analogs 414
2.13.17 Tyrosine kinase inhibitors 415
2.13.18 Antineoplastic drugs with endocrine effects 416
2.13.19 Other antineoplastic agents 417
References 419
2.14 - Uterine contraction agents, tocolytics, vaginal therapeutics and local contraceptives 428
2.14.1 Prostaglandins 428
2.14.2 Oxytocin 430
2.14.3 Ergot alkaloids 431
2.14.4 Tocolytics in general 432
2.14.5 ß2-Sympathomimetics 433
2.14.6 Calcium antagonists 434
2.14.7 Magnesium sulfate 434
2.14.8 Oxytocin receptor antagonists 435
2.14.9 Prostaglandin antagonists 435
2.14.10 Other tocolytics 436
2.14.11 Vaginal therapeutics 436
2.14.12 Spermicide contraceptives 437
2.14.13 Intrauterine devices 437
References 438
2.15 - Hormones 440
2.15.1 Hypothalamic releasing hormones 441
2.15.2 Anterior pituitary hormones 442
2.15.3 Prolactin antagonists/dopamine agonists 443
2.15.4 Posterior pituitary hormones 444
2.15.5 Thyroid function and iodine supply during pregnancy 444
2.15.6 Hypothyroidism, triiodothyronine (T3) and thyroxin (T4) 445
2.15.7 Hyperthyroidism and thyrostatics 446
2.15.8 Glucocorticoids 450
2.15.9 Diabetes mellitus and pregnancy 453
2.15.10 Insulin 455
2.15.11 Oral antidiabetics (OAD) 457
2.15.12 Estrogens 461
2.15.13 Gestagens 462
2.15.14 Duogynon® 464
2.15.15 Diethylstilbestrol 464
2.15.16 Androgens and anabolics 465
2.15.17 Cyproterone and danazol 466
2.15.18 Mifepristone (RU486) 467
2.15.19 Clomiphene 467
2.15.20 Erythropoietin 468
References 469
2.16 - General and local anesthetics and muscle relaxants 478
2.16.1 Halogenated inhalational anesthetic agents 479
2.16.2 Ether (diethyl ether) 481
2.16.3 Nitrous oxide 481
2.16.4 Xenon 481
2.16.5 Occupational exposure to anesthetic gases 481
2.16.6 Injection anesthetics 482
2.16.7 Local anesthetics 484
2.16.8 Muscle relaxants 487
References 489
2.17 - Dermatological medications and local therapeutics 494
2.17.1 Typical skin changes during pregnancy 495
2.17.2 Antiseptics and disinfectants 495
2.17.3 Glucocorticoids and non-steroid antiphlogistics 498
2.17.4 Astringents 498
2.17.5 Antipruritics and essential oils 499
2.17.6 Coal tar and slate oil preparations 499
2.17.7 Local immunomodulators as therapy for atopic eczema 500
2.17.8 Keratolytics 500
2.17.9 Retinoids for acne and psoriasis therapy 502
2.17.10 Ultraviolet light 506
2.17.11 Fumaric acid preparations 506
2.17.12 Biologicals 507
2.17.13 Wart therapeutics 507
2.17.14 Lithium 508
2.17.15 Lice medications 508
2.17.16 Anti-scabies 509
2.17.17 Vein therapeutics 510
2.17.18 Antihidrotica 510
2.17.19 Eflornithine, finasteride and minoxidil 511
2.17.20 Repellents 512
2.17.21 Cosmetics 512
2.17.22 Eye, nose and ear drops 513
2.17.23 Hemorrhoid medications 515
2.17.24 Vaginal therapeutics 515
References 515
2.18 - Vitamins, minerals and trace elements 520
2.18.1 Vitamin A (retinol) 521
2.18.2 Vitamin B1 (thiamine) 523
2.18.3 Vitamin B2 (riboflavin) 523
2.18.4 Vitamin B3 (nicotinamide) 524
2.18.5 Vitamin B6 (pyridoxine) 524
2.18.6 Vitamin B12 (cyanocobalamin) 524
2.18.7 Vitamin C (ascorbic acid) 525
2.18.8 Folic acid 525
2.18.9 Vitamin D group 528
2.18.10 Vitamin E (tocopherol) 529
2.18.11 Vitamin K 530
2.18.12 Multivitamin preparations 530
2.18.13 Iron 530
2.18.14 Calcium 531
2.18.15 Fluoride 532
2.18.16 Strontium 533
2.18.17 Biphosphonates and other osteoporosis drugs 533
2.18.18 Iodide 534
2.18.19 Trace elements 534
References 534
2.19 - Herbs during pregnancy 538
2.19.1 The safety of herbs during pregnancy 538
2.19.2 Counseling a pregnant woman about herbs 539
2.19.3 General concepts regarding the use of herbs during pregnancy 540
2.19.4 Herbs used as foods 541
2.19.5 Essential oils that are safe during pregnancy 541
2.19.6 Herbs frequently used during pregnancy 541
2.19.7 Herbs controversially used during pregnancy 542
2.19.8 Herbs contraindicated during pregnancy 547
References 550
2.20 - Diagnostic agents 554
2.20.1 Diagnostic imaging 554
2.20.2 Contrast media 558
2.20.3 Radioactive isotopes 561
2.20.4 Stable isotopes 563
2.20.5 Dyes 564
2.20.6 Other diagnostic agents 565
References 565
2.21 - Recreational drugs 568
Introduction 568
2.21.1 Alcohol 569
2.21.2 Caffeine and other xanthines 574
2.21.3 Tobacco and smoking 576
2.21.4 Drugs of abuse in general (excluding caffeine) 582
2.21.5 Sedating drugs 589
References 592
2.22 - Poisonings and toxins 602
2.22.1 The general risk of poisoning in pregnancy 602
2.22.2 Treatment of poisoning in pregnancy 603
2.22.3 Medicines 609
2.22.4 Animal toxins 617
2.22.5 Mushrooms 619
2.22.6 Other plant toxins 619
2.22.7 Bacterial endotoxins 619
References 620
2.23 - Occupational, industrial and environmental agents 626
2.23.1 Solvent exposure in general 628
2.23.2 Formaldehyde and formalin 634
2.23.3 Photographic/printing chemicals 634
2.23.4 Pesticides 635
2.23.5 Phenoxyacetic acid derivatives and polychlorinated dibenzo-dioxins 639
2.23.6 Polychlorinated biphenyls 641
2.23.7 Chlorinated drinking water by-products 641
2.23.8 Metals 643
2.23.9 Hazardous waste landfill sites and waste incinerators 649
2.23.10 Radiation associated with the nuclear industry 650
2.23.11 Cell/mobile phones 652
2.23.12 Other sources of electromagnetic radiation 652
2.23.13 Electric shocks and lightning strikes 654
References 655
3 - General commentary on drug therapy and drug risk during lactation 666
3.1 The advantages of breastfeeding versus the risks of maternal medication 666
3.2 The passage of medications into the mother’s milk 668
3.3 Infant characteristics 669
3.4 Milk plasma ratio 670
3.5 Amount of medication in the milk and relative dose 671
3.6 Toxicity of medications in the mother’s milk 672
3.7 Medications that affect lactation 674
3.8 Breastfeeding support 675
References 676
4 - Specific drug therapies during lactation 678
4.1 - Analgesics, antiphlogistics and anesthetics 680
4.1.1 Paracetamol 680
4.1.2 Acetylsalisylic acid 681
4.1.3 Pyrazolone and phenylbutazone derivatives 682
4.1.4 Non-steroidal anti-inflammatory drugs (NSAID) 682
4.1.5 Selective COX-2 inhibitors 684
4.1.6 Other antirheumatics 685
4.1.7 Migraine medications 686
4.1.8 Opioids and opioid derivatives 687
4.1.9 Local anesthetics 691
4.1.10 Other medications used in connection with anesthesia 692
4.1.11 Myotonolytics and other analgesics 693
4.1.12 Gout therapy 693
References 694
4.2 - Antiallergics, antiasthmatics and antitussives 698
4.2.1 Antihistamines (H1-blocker) 698
4.2.2 Selective effective ß2-sympathomimetics 699
4.2.3 Inhalable corticosteroids (ICS) 700
4.2.4 Leukotrien-receptor antagonists 700
4.2.5 Theophylline 701
4.2.6 Mast cell inhibitors 701
4.2.7 Anticholinergics for asthma treatment 701
4.2.8 Omalizumab 702
4.2.9 Mucolytics, expectorants and cold remedies 702
4.2.10 Antitussives 702
References 703
4.3 - Gastrointestinal drugs 704
4.3.1 Gastritis and ulcer medications 704
4.3.2 Peristaltic stimulators 706
4.3.3 Cholinergics 707
4.3.4 Anticholinergic spasmolytics 708
4.3.5 Laxatives 708
4.3.6 Agents used for chronic inflammatory bowel diseases 709
4.3.7 Antidiarrheals for acute diarrhea 710
4.3.8 Digestives and carminatives 710
4.3.9 Lipid reducers 710
4.3.10 Chenodeoxycholic acid and ursodeoxycholic acid 711
4.3.11 Appetite suppressants 711
4.3.12 Antiemetics 711
References 712
4.4 - Anti-infectives 714
4.4.1 Penicillins, cephalosporins and other ß-lactam antibiotics 715
4.4.2 Erythromycin and other macrolides 715
4.4.3 Tetracyclines 716
4.4.4 Sulfonamides and trimethoprim 716
4.4.5 Quinolones 717
4.4.6 Nitrofurans and drugs for urinary tract infections 717
4.4.7 Nitroimidazole antibiotics 718
4.4.8 Aminoglycosides 719
4.4.9 Glycopeptide and polypeptide antibiotics 719
4.4.10 Other antibiotics 719
4.4.11 Tuberculostatics 720
4.4.12 Local antibiotics 721
4.4.13 Antimalarial medication 722
4.4.14 Systemic antifungal agents 723
4.4.15 Topical antifungal agents 723
4.4.16 Anthelmintics 724
4.4.17 Antiviral agents 724
References 727
4.5 - Vaccines and immunoglobulins 732
4.5.1 Maternal immunization 732
4.5.2 Efficacy of immunization in breastfed infants 733
4.5.3 Hepatitis A vaccine 733
4.5.4 Hepatitis B vaccine 733
4.5.5 Human papillomavirus vaccine 734
4.5.6 Influenza vaccine 734
4.5.7 Polio vaccine 734
4.5.8 Rabies vaccine 735
4.5.9 Rubella vaccine 735
4.5.10 Smallpox vaccine 735
4.5.11 Typhoid vaccine 735
4.5.12 Immunoglobulins 736
4.5.13 CDC recommendations 736
References 737
4.6 - Cardiovascular drugs and ­diuretics 738
4.6.1 ß-Receptor blockers 738
4.6.2 Hydralazine 740
4.6.3 a-Methyldopa 740
4.6.4 Calcium antagonists 741
4.6.5 ACE inhibitors 742
4.6.6 Angiotensin-II receptor-antagonists (sartan) 742
4.6.7 Other antihypertensives 743
4.6.8 Antihypotensives 744
4.6.9 Digitalis 744
4.6.10 Antiarrhythmics 744
4.6.11 Vasodilators and circulatory drugs 746
4.6.12 Diuretics 747
References 748
4.7 - Anticoagulants, thrombocyte aggregation inhibitors and fibrinolytics 752
4.7.1 Heparin and danaparoid 752
4.7.2 Thrombin- and factor Xa-inhibitors 753
4.7.3 Thrombocyte aggregation inhibitors 753
4.7.4 Vitamin K-antagonists 754
4.7.5 Fibrinolytics 755
4.7.6 Antihemorrhagics 755
4.7.7 Volume expanders 755
References 756
4.8 - Antiepileptics 758
4.8.1 Introduction 758
4.8.2 Individual antiepileptics 759
References 766
4.9 - Psychotropic drugs 770
4.9.1 Introduction 770
4.9.2 Antidepressants 770
4.9.3 Individual antidepressants 772
4.9.4 Antipsychotic 782
4.9.5 Individual antipsychotic drugs 783
4.9.6 Lithium and other antimanic drugs 789
4.9.7 Anxiolytics, hypnotics and sedatives 791
4.9.8 Benzodiazepines 791
4.9.9 Zaleplon, zolpidem and zopiclone 794
4.9.10 Other anxiolytics, hypnotics and sedatives 794
4.9.11 Psychoanaleptics 795
4.9.12 Anti-Parkinson drugs 796
References 796
4.10 - Immunomodulating and antineoplastic agents 802
4.10.1 Azathioprine and 6-mercaptopurine 802
4.10.2 Selective immune suppressants 803
4.10.3 Monoclonal antibodies (mAb) and other biologicals 804
4.10.4 Interferons 805
4.10.5 Other immune stimulants 806
4.10.6 Antineoplastics 806
References 807
4.11 - Hormones and hormone antagonists 810
4.11.1 Pituitary and hypothalamic hormones 810
4.11.2 Methylergometrine (methylergonovine) 811
4.11.3 Bromocriptine and other prolactin inhibitors 812
4.11.4 Thyroid hormones and thyroid receptor antibodies (TRAb) 812
4.11.5 Thyrostatics 813
4.11.6 Iodine 814
4.11.7 Corticosteroids 815
4.11.8 Adrenaline 816
4.11.9 Insulin and oral antidiabetics 816
4.11.10 Estrogens, gestagens, and hormonal contraceptives 817
4.11.11 Androgens and anabolics 819
4.11.12 Cyproterone acetate and other sex-hormone inhibitors 819
4.11.13 Prostaglandins 820
References 820
4.12 - Dermatological medication and local therapeutics 824
4.12.1 Topical applications and cosmetics 824
4.12.2 Essential oils 825
4.12.3 Retinoids and topicals for psoriasis, dermatitis and acne 825
4.12.4 Photochemotherapy and fumaric acid preparations 826
4.12.5 Wart removal medications 826
4.12.6 Medications for lice and scabies 826
4.12.7 Eye, nose and ear drops 827
4.12.8 Vein therapeutics and other local therapeutics 828
4.12.9 Vaginal therapeutics 828
References 829
4.13 - Alternative remedies, vitamins, and minerals 830
4.13.1 Alternative remedies and phytotherapeutics 830
4.13.2 Herbal galactogogues and antigalactogogues 832
4.13.3 Topical treatment for breast problems 834
4.13.4 Vitamins, minerals, and trace elements 835
4.13.5 Biphosphonates 835
4.13.6 Exercise 836
4.13.7 Glucose 6-phosphate-dehydrogenase deficiency 836
References 837
4.14 - Contrast media, radionuclides and diagnostics 840
4.14.1 X-ray studies, ultrasound, and magnetic resonance imaging 840
4.14.2 Iodine-containing contrast media 840
4.14.3 Magnetic resonance contrast agents 842
4.14.4 Ultrasound contrast media 843
4.14.5 Radionuclides 843
4.14.6 Dyes 844
4.14.7 Other diagnostics 845
References 845
4.15 - Infections during breastfeeding 848
4.15.1 Common infections 849
4.15.2 Cytomegaly 849
4.15.3 Dengue virus 850
4.15.4 Hepatitis A 850
4.15.5 Hepatitis B 851
4.15.6 Hepatitis C 851
4.15.7 Hepatitis E 851
4.15.8 Herpes simplex 852
4.15.9 Herpes zoster (shingles), chicken pox (varicella) 852
4.15.10 HIV infection 853
4.15.11 Human T-lymphotropic virus (HTLV) 854
4.15.12 Influenza 854
4.15.13 Lyme disease 855
4.15.14 Methicillin-resistant Staphylococcus aureus (MRSA) 855
4.15.15 Rotavirus 855
4.15.16 Tuberculosis 856
4.15.17 West Nile virus 857
4.15.18 Other infectious diseases 857
References 857
4.16 - Recreational drugs 862
4.16.1 Alcohol 862
4.16.2 Amphetamines 863
4.16.3 Caffeine 863
4.16.4 Cannabis 864
4.16.5 Cocaine 864
4.16.6 Nicotine 865
4.16.7 Opiates, including methadone 866
4.16.8 Other drugs 868
References 868
4.17 - Plant toxins 872
References 
872 
4.18 - Industrial chemicals and environmental contaminants 874
4.18.1 Persistent organochlorine compounds (pesticides, polychlorinated biphenyls and dioxins) 874
4.18.2 Mercury 878
4.18.3 Lead 880
4.18.4 Cadmium 882
4.18.5 Other contaminants 882
4.18.6 Breastfeeding despite environmental contaminants? 884
4.18.7 Breastfeeding and the workplace 885
References 886
Index 890