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References
Table 6: Maternal Medication Usually Compatible With Breast-Feeding, from the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk ,
revised September 2001.
Hale, Thomas. Medications and Mothers Milk, 12th Edition. Hale Publishing, 2006. Dr. Hales website is located at http://neonatal.ttuhsc.edu/lact/index.html.
Generic name Trade Name AAP
approved?*
Pregnancy
Risk
Category**
Lactation
Risk
Category**
Analgesics (Pain-killers) [more]
Acetaminophen Tylenol Approved B L1
Colchicine Colchicine Approved D L4
Nefopam Acupan Approved - NR
Non-steroidal anti-inflammatory analgesics (NSAIDs) [more]
Azapropazone (apazone) Rheumox Approved - L2
Dipyrone (banned in the US &
UK)
- Approved - NR
Flufenamic acid - Approved - NR
Ibuprofen Advil, Nuprin,
Motrin,
Pediaprofin
Approved B (1st, 2nd
trim.)
D (3rd
trim.)
L1
Indomethacin Indocin Approved B (1st, 2nd
trim.)
D (3rd
trim.)
L3
Ketorolac Toradol, Acular Approved B (1st, 2nd
trim.)
D (3rd
trim.)
L2
Mefenamic acid Ponstan, Ponstel Approved - NR
Naproxen Anaprox,Naprosyn,
Naproxen, Aleve
Approved B L3L4 (for
chronic use)
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References
Table 6: Maternal Medication Usually Compatible With Breast-Feeding, from the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk ,
revised September 2001.
Hale, Thomas. Medications and Mothers Milk, 12th Edition. Hale Publishing, 2006. Dr. Hales website is located at http://neonatal.ttuhsc.edu/lact/index.html.
Phenylbutazone Butazolidine Approved - NR
Piroxicam Feldene Approved B L2
Suprofen Profenal Approved - NR
Tolmetin Tolectin Approved C L3
Narcotic analgesics[more]
Butorphanol Stadol Approved B (1st, 2nd
trim.)
D (3rd
trim.)
L3
Codeine Tylenol #3, #4 Approved C L3
Fentanyl Sublimaze Approved B L2
Meperidine Demerol Approved B L2
L3 (if used
early
postpartum)
Methadone Dolophine Approved B L3
Morphine Morphine Approved B L3
Propoxyphene Darvocet N,Propacet, Darvon
Approved C L2
Anesthesia, Anesthetics [more] [contents]
Halothane Fluothane Approved C L2
Lidocaine Xylocaine Approved C L2
Methohexital Brevital Approved B L3
Thiopental Pentothal Approved C L3
Antacids, GI meds [contents]
Cimetidine (Antacid) Tagamet Approved B L2
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References
Table 6: Maternal Medication Usually Compatible With Breast-Feeding, from the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk ,
revised September 2001.
Hale, Thomas. Medications and Mothers Milk, 12th Edition. Hale Publishing, 2006. Dr. Hales website is located at http://neonatal.ttuhsc.edu/lact/index.html.
Cisapride (GI tract stimulant) Propulsid Approved C L2
Domperidone (used for nausea
& vomiting, stimulates lactation)
[more]
Motilum Approved - L1
Antibiotics [contents]
Amoxicillin Larotid, Amoxil Approved B L1
Aztreonam Azactam Approved B L2
Cefadroxil Ultracef, Duricef Approved B L1
Cefazolin Ancef, Kefzol Approved B L1
Cefotaxime Claforan Approved B L2
Cefoxitin Mefoxin Approved B L1
Cefprozil Cefzil Approved C L1
Ceftazidime Ceftazidime,
Fortaz, Taxidime
Approved B L1
Ceftriaxone Rocephin Approved B L2
Ciprofloxacin [more] Cipro Approved C L3
Clindamycin Cleocin Approved B L3
Erythromycin E-Mycin, Ery-
tab, ERYC,
Ilosone
Approved B L1
L3 early
postnatal
Fleroxacin - Approved - NR
Gentamicin Garamycin Approved C L2
Kanamycin Kebecil, Kantrex Approved D L2
Moxalactam Moxam Approved - NR
Nitrofurantoin Macrobid Approved B L2
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References
Table 6: Maternal Medication Usually Compatible With Breast-Feeding, from the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk ,
revised September 2001.
Hale, Thomas. Medications and Mothers Milk, 12th Edition. Hale Publishing, 2006. Dr. Hales website is located at http://neonatal.ttuhsc.edu/lact/index.html.
Ofloxacin Floxin Approved C L2
Penicillin - Approved B L1
Streptomycin Streptomycin Approved D L3
Sulbactam - Approved - NR
Sulfisoxazole Gantrisin, Azo-
Gantrisin
Approved C L2
Tetracycline Achromycin,
Sumycin,
Terramycin
Approved D L2
Ticarcillin Ticarcillin,
Ticar, Timentin
Approved B L1
Trimethoprim/sulfamethoxazole Proloprim,
Trimpex
Approved C L3
Anticoagulants [contents]
Bishydroxycoumarin
(dicumarol)
- Approved - NR
Warfarin Coumadin,
Panwarfin
Approved D L2
Anticonvulsants [contents]
Carbamazepine Tegretol, Epitol Approved C L2
Ethosuximide Zarontin Approved C L4
Magnesium sulfate Epsom salt Approved B L1
Phenytoin Dilantin Approved D L2
Valproic acid Depakene,
Depakote
Approved D L2
Antifungals [contents]
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References
Table 6: Maternal Medication Usually Compatible With Breast-Feeding, from the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk ,
revised September 2001.
Hale, Thomas. Medications and Mothers Milk, 12th Edition. Hale Publishing, 2006. Dr. Hales website is located at http://neonatal.ttuhsc.edu/lact/index.html.
Fluconazole [more] Diflucan Approved C L2
Ketoconazole Nizoral
Shampoo,
Nizoral
Approved C L2
Antihistamines [more] [contents]
Dexbrompheniramine maleate
with d-isoephedrine
- Approved - NR
Fexofenadine Allegra Approved C L2
Loratadine Claritin Approved B L1
Terfenadine Seldane Approved - NR
Triprolidine Actidil, Actifed Approved C L1
Antivirals [contents]
Acyclovir[more] Zovirax Approved C L2
Interferon-alpha [more] Alferon N,
Interferon Alpha
Approved C L2
Arthritis meds (see also:pain meds) [contents]
Gold salts Ridaura,
Myochrysine,
Solganal
Approved C L5
Asthma meds (see also:steroids) [contents]
Dyphylline Dilor, Lufyllin,
Dyphylline
Approved C L3
Terbutaline Bricanyl,
Brethine
Approved B L2
Theophylline Aminophylline,
Quibron, Theo-
Dur
Approved C L3
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References
Table 6: Maternal Medication Usually Compatible With Breast-Feeding, from the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk ,
revised September 2001.
Hale, Thomas. Medications and Mothers Milk, 12th Edition. Hale Publishing, 2006. Dr. Hales website is located at http://neonatal.ttuhsc.edu/lact/index.html.
Contraceptives, Hormones [more] [contents]
Estradiol Estratab,
Permarin,
Menest
Approved X L3 (may
interfere with
milk
production)
Clogestone - Approved - NR
Contraceptive pill with
estrogen/progesterone
Preven,
Seasonale,
Norinyl,
Norlestin, Ortho-
Novum, Ovral,
Lunelle
injection, Ortho-
Evra patch, etc.
Approved X L3 (may
interfere with
milk
production)
Levonorgestrel Norplant,
Mirena, Plan B
Approved X L2
Medroxyprogesterone Provera, Depo-
Provera, Cycrin
Approved D L1
L4 (if used
first 3 days
postpartum)
Norethynodrel Enovid Approved X L2
Progesterone Crinone,
Prometrium
Approved - L3
Cough meds [more] [contents]
Codeine Tylenol #3, #4 Approved C L3
Noscapine - Approved - NR
Decongestants [more] [contents]
Pseudoephedrine Sudafed,
Halofed,
Approved C L3 (for acute
use)
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References
Table 6: Maternal Medication Usually Compatible With Breast-Feeding, from the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk ,
revised September 2001.
Hale, Thomas. Medications and Mothers Milk, 12th Edition. Hale Publishing, 2006. Dr. Hales website is located at http://neonatal.ttuhsc.edu/lact/index.html.
Novafed, Actifed L4 (for
chronic use)
Diabetes meds [contents]
Note: Insulin has not been reviewed by the AAP. Pregnancy risk category = B; Lactation riskcategory = L1.
Tolbutamide Oramide,
Orinase
Approved D L3
Diarrhea meds [contents]
Loperamide Imodium, Pepto
Diarrhea
Control, Maalox
Antidiarrheal
Caplets,
Kaopectate II
Caplets,
Immodium
Advanced
Approved B L2
** Note: Pepto-Bismol & Kaopectate (bismuth subsalicylate is the active ingredient in both)
are not recommended for routine use by nursing moms, due to the association of salicylates
with Reyes syndrome in children.[more]
Diuretics [contents]
Acetazolamide Dazamide,
Diamox
Approved C L2
Bendroflumethiazide Naturetin Approved D L4 (may
inhibit
lactation)
Chlorothiazide Hydrodiuril Approved D L3
Chlorthalidone Hygroton Approved D L3
Hydrochlorothiazide Hydrodiuril, Approved D L2
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References
Table 6: Maternal Medication Usually Compatible With Breast-Feeding, from the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk ,
revised September 2001.
Hale, Thomas. Medications and Mothers Milk, 12th Edition. Hale Publishing, 2006. Dr. Hales website is located at http://neonatal.ttuhsc.edu/lact/index.html.
Esidrix, Oretic
Spironolactone Aldactone Approved D L2
Galactagogues (milk supply) [more] [contents]
Domperidone Motilum Approved - L1
Heart, Blood Pressure meds
(Antiarrhythmics, Antihypertensives, Cardiac stimulants)
[contents]
Antiarrhythmics
Disopyramide Norpace,
Napamide
Approved C L2
Flecainide Tambocor Approved C L3
Mexiletine Mexitil Approved B L2
Procainamide Pronestyl,
Procan
Approved C L3
Quinidine Quinaglute,
Quinidex
Approved C L2
Antihypertensives
Captopril Capoten Approved D L3 (if used
after 30 days)
Diltiazem/Diltiazem HCL Cardizem Sr,
Dilacor-XR,
Diltiazem,
Cardizem CD
Approved C L3
Enalapril/Enalapril Maleate Vasotec Approved C (1st
trim.)
D (2nd, 3rd
trim.)
L2
Hydralazine Apresoline Approved C L2
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References
Table 6: Maternal Medication Usually Compatible With Breast-Feeding, from the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk ,
revised September 2001.
Hale, Thomas. Medications and Mothers Milk, 12th Edition. Hale Publishing, 2006. Dr. Hales website is located at http://neonatal.ttuhsc.edu/lact/index.html.
Labetalol Trandate,
Normodyne
Approved C L2
Methyldopa Aldomet Approved C L2
Metoprolol Toprol XL,Lopressor
Approved B L3
Minoxidil Loniten,
Minodyl,
Rogaine
Approved C L2(topically)
L3 (orally)
Nadolol Corgard, Nadolol Approved C L4
Nifedipine Adalat, Procardia Approved C L2
Oxprenolol Apsolox, Slow-Trasicor,
Trasicor
Approved - NR
Propranolol Inderol Approved C L2
Sotalol Betapace Approved B L3
Timolol Blocadren Approved C L2
Verapamil Calan, Isoptin,
Covera-HS
Approved C L2
Cardiac stimulants
Digoxin Lanoxin,
Lanoxicaps
Approved C L2
Laxatives [more] [contents]
Cascara/Cascara Sagrada - Approved C L3
Danthron - Approved - NR
Magnesium sulfate Epsom salt Approved B L1
Senna - Approved - L3
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References
Table 6: Maternal Medication Usually Compatible With Breast-Feeding, from the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk ,
revised September 2001.
Hale, Thomas. Medications and Mothers Milk, 12th Edition. Hale Publishing, 2006. Dr. Hales website is located at http://neonatal.ttuhsc.edu/lact/index.html.
Malaria meds [contents]
Chloroquine Aralen, Novo-
chloroquine
Approved C L3
Hydroxychloroquine Plaquenil Approved C L2
Pyrimethamine Daraprim Approved C L4
Quinine Quinamm Approved D L2
Medical Testing [more] [contents]
Diatrizoate - Approved - NR
Fluorescein - Approved C L3
Gadopentetic (Gadolinium) - Approved C L2
Iohexol Omnipaque Approved B L2
Iopanoic acid Telepaque Approved D L2
Metrizamide Amipaque Approved B L2
Metrizoate Isopaque Approved B L2
Migraine meds (see also:pain meds)[more] [contents]
Sumatriptan Imitrex Approved C L3
Sedatives [more] [contents]
Chloral hydrate Aquachloral,
Noctec
Approved C L3
Methyprylon (withdrawn from
use in US & Canada)
- Approved - NR
Bromide - Approved D L5
Secobarbital Seconal Approved D L3
Sleep Aids [contents]
Zolpidem/Zolpidem Tartrate Ambien Approved B L3
http://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/radioisotopeshttp://www.kellymom.com/bf/can-i-breastfeed/meds/radioisotopeshttp://www.kellymom.com/bf/can-i-breastfeed/meds/radioisotopeshttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#Painhttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#Painhttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#Painhttp://www.kellymom.com/bf/can-i-breastfeed/meds/migraine-medshttp://www.kellymom.com/bf/can-i-breastfeed/meds/migraine-medshttp://www.kellymom.com/bf/can-i-breastfeed/meds/migraine-medshttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/sedationhttp://www.kellymom.com/bf/can-i-breastfeed/meds/sedationhttp://www.kellymom.com/bf/can-i-breastfeed/meds/sedationhttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/sedationhttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/migraine-medshttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#Painhttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/radioisotopeshttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#toc -
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References
Table 6: Maternal Medication Usually Compatible With Breast-Feeding, from the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk ,
revised September 2001.
Hale, Thomas. Medications and Mothers Milk, 12th Edition. Hale Publishing, 2006. Dr. Hales website is located at http://neonatal.ttuhsc.edu/lact/index.html.
Steroids [contents]
Methylprednisolone
[ high dosage
methylprednisolone]
Solu-Medrol,
Depo-Medrol,
Medrol
Approved C L2
Prednisolone - Approved C L2
Prednisone Deltasone,
Meticorten,
Orasone
Approved C L2
Thyroid meds [more] [contents]
Carbimazole - Approved D L3
Methimazole (active metaboliteof carbimazole)
Tapazole Approved D L3
Propylthiouracil PTU Approved D L2
Thiouracil - Approved - NR
Levothyroxine Synthroid,
Levothroid,
Thyroid, Levo-T,
Levoxyl
Approved A L1
Tuberculosis meds [contents]
Cycloserine Seromycin Approved C L3
Ethambutol Ethambutol,
Myambutol
Approved B L2
Isoniazid INH, Laniazid Approved C L3
Rifampin Rifadin,
Rimactane
Approved C L2
Vitamins [more] [contents]
B-1 (thiamin) - Approved - NR
http://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://images.wikia.com/twhicufellows/images/9/99/Hugenholtz2002.pdfhttp://images.wikia.com/twhicufellows/images/9/99/Hugenholtz2002.pdfhttp://images.wikia.com/twhicufellows/images/9/99/Hugenholtz2002.pdfhttp://images.wikia.com/twhicufellows/images/9/99/Hugenholtz2002.pdfhttp://www.kellymom.com/health/thyroid/index.htmlhttp://www.kellymom.com/health/thyroid/index.htmlhttp://www.kellymom.com/health/thyroid/index.htmlhttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/nutrition/vitamins/index.htmlhttp://www.kellymom.com/nutrition/vitamins/index.htmlhttp://www.kellymom.com/nutrition/vitamins/index.htmlhttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/nutrition/vitamins/index.htmlhttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#tochttp://www.kellymom.com/health/thyroid/index.htmlhttp://images.wikia.com/twhicufellows/images/9/99/Hugenholtz2002.pdfhttp://images.wikia.com/twhicufellows/images/9/99/Hugenholtz2002.pdfhttp://www.kellymom.com/bf/can-i-breastfeed/meds/aap-approved-meds#toc -
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References
Table 6: Maternal Medication Usually Compatible With Breast-Feeding, from the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk ,
revised September 2001.
Hale, Thomas. Medications and Mothers Milk, 12th Edition. Hale Publishing, 2006. Dr. Hales website is located at http://neonatal.ttuhsc.edu/lact/index.html.
Carbetocin (Antihemorrhagic) Duratocin Approved - NR
Chloroform - Approved - NR
Cisplatin (Anti-cancer) Platinol Approved D L4
Dapsone (Antileprosy) Avlosulfon, DDS Approved C L4
Hydroxychloroquine
(Antirheumatic, lupus)
Plaquenil Approved C L2
Iodides - Approved - NR
Iodine - Approved - NR
Iodine (povidone-iodine, eg, in a
vaginal douche)
- Approved - NR
Ivermectin (Antiparasitic) Mectizan Approved C L3
Nalidixic acid (Urinary Anti-
infective)
NegGram Approved B L4
Norsteroids - Approved - NR
Pyridostigmine (Muscle
stimulant)
Mestinon,
Regonol
Approved C L2
Scopolamine (Motion sickness) Transderm
Scope
Approved C L3
Sulfapyridine Dagenan Approved - NR
Timolol (glaucoma med) Blocadren Approved D L3
* Per the AAP Policy StatementThe Transfer of Drugs and Other Chemicals Into Human
Milk, revised September 2001.
Approved: (Table 6)Maternal Medication Usually Compatible With Breastfeeding Caution: (Table 5)Drugs That Have Been Associated With Significant Effects on Some
Nursing Infants and Should Be Given to Nursing Mothers With Caution NR: Not Reviewed. This drug has not yet been reviewed by the AAP.** PerMedications and Mothers Milkby Thomas Hale, PhD (2004 edition).
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T6http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T6http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T6http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T5http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T5http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T5http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T5http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T5http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T5http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T6http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 -
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References
Table 6: Maternal Medication Usually Compatible With Breast-Feeding, from the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk ,
revised September 2001.
Hale, Thomas. Medications and Mothers Milk, 12th Edition. Hale Publishing, 2006. Dr. Hales website is located at http://neonatal.ttuhsc.edu/lact/index.html.
Lactation Risk Categories Pregnancy Risk Categories
L1 (safest) L2 (safer) L3 (moderately safe) L4 (possibly hazardous) L5 (contraindicated)
A (controlled studies show no risk) B (no evidence of risk in humans) C (risk cannot be ruled out) D (positive evidence of risk) X (contraindicated in pregnancy)
NR: Not Reviewed. This drug has not yet been reviewed by Hale.