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Long-acting bronchodilators: Implications for pregnancy and lactation

Agent	Human data	Adverse events in animal studies	Crosses placenta	Excreted in human milk
Long-acting beta agonists*
Salmeterol	Limited data suggest safety	Observed in some studies		Unknown
Formoterol	Limited data suggest safety	Observed in some studies		Unknown
Indacaterol^¶		No		Unknown
Olodaterol^¶		Yes		Unknown, but likely
Vilanterol^Δ		No		Unknown
Long-acting anticholinergic agents
Aclidinium^¶		Yes	Not known	Probable
Glycopyrrolate^¶		Yes	Small amounts	Yes
Tiotropium		Yes	Not known	Not known
Umeclidinium^¶			Negligible systemic absorption following oral inhalation	Not known

Data obtained from package inserts. Refer to the UpToDate topic on the management of asthma in pregnancy for additional information.

* Long-acting beta agonists (LABAs) should be used for asthma in combination with inhaled glucocorticoids, and not as monotherapy. LABAs have the potential to decrease uterine contractility, if administered during labor. LABAs are not considered a contraindication to breast feeding, when necessary to control asthma.
¶ Not approved by the US Food and Drug Administration for use in asthma.
Δ Approved for use in asthma in the combination preparation fluticasone-vilanterol.

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