It is not known if apixaban or its metabolites are excreted in human milk. The molecular weight, partial metabolism, moderate plasma protein binding, and long effective half-life suggest that the drug will be excreted into human milk. Women should be instructed to discontinue breast-feeding or to discontinue apixaban, taking into account the importance of the drug to the mother. If pharmacotherapy is necessary in the nursing mother, the American Academy of Pediatrics (AAP) considers warfarin to be usually compatible with breast-feeding. Low-molecular weight heparins and heparin have relatively high molecular weights ; therefore, these drugs are not expected to be excreted into human milk to a clinically significant degree. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.
Anabolic steroids are synthetic derivatives of testosterone . Certain clinical effects and adverse reactions demonstrate the androgenic properties of this class of drugs. Complete dissociation of anabolic and androgenic effects has not been achieved. The actions of anabolic steroids are therefore similar to those of male sex hormones with the possibility of causing serious disturbances of growth and sexual development if given to young children. Anabolic steroids suppress the gonadotropic functions of the pituitary and may exert a direct effect upon the testes .