Is Artesunate safe while breastfeeding?

Summary of use during breastfeeding

Limited information indicates that a maternal dose of 200 mg orally produced low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Withholding breastfeeding for 6 hours after a dose should markedly reduce the dose the infant receives.

In general, very small amounts of antimalarial drugs are excreted in the breast milk of lactating women. Because the quantity of antimalarial drugs transferred in breast milk is insufficient to provide adequate protection against malaria, infants who require chemoprophylaxis must receive the recommended dosages of antimalarial drugs.[1]

Effects on the breastfed infant

Breastfed infants who were given dihydroartemisinin and piperaquine as a treatment for malaria had a higher frequency of vomiting than non-breastfed infants given the drugs. Whether this finding applies to infants who receive dihydroartemisinin via breastmilk has not been studied.[3]

Effects on milk supply

Relevant published information was not found as of the revision date.

Levels in milk

Maternal Levels. After a single oral dose of 200 mg of artesunate given to nursing mothers (number not stated), artesunate was undetectable in breastmilk (<5 mcg/L) at any time. The active metabolite, dihydroartemisinin, reached a peak concentration in breastmilk of about 35 mcg/L at 90 minutes after the dose, and was undetectable (<2.5 mcg/L) 6 hours after the dose.[2]

Infant Levels. Relevant published information was not found as of the revision date.