Is Atovaquone and Proguanil safe while breastfeeding?
Here is what LactMed, the Drugs and Lactation Database published by the U.S. National Institute of Child Health and Human Development (NICHD), reports about Atovaquone and Proguanil. The text below is quoted from that source — it is not our own verdict.
Summary of use during breastfeeding
No information is available on the use of atovaquone and proguanil during breastfeeding. The Centers for Disease Control and Prevention does not currently recommend it for the prevention of malaria in women breastfeeding infants weighing less than 5 kg (11 pounds). However, it can be used for treatment of women who are breastfeeding infants of any weight when the potential benefit outweighs the potential risk to the infant (e.g., treating a breastfeeding woman who has acquired P. falciparum malaria in an area of multidrug-resistant strains and who cannot tolerate other treatment options).[1]
In general, only small amounts of antimalarial drugs are excreted in the breastmilk of lactating women. Because the quantity of antimalarial drugs transferred in breastmilk is insufficient to provide adequate protection against malaria, infants who require chemoprophylaxis must also receive the recommended dosages of antimalarial drugs.[1]
Effects on the breastfed infant
Relevant published information was not found as of the revision date.
Effects on milk supply
Relevant published information was not found as of the revision date.
Levels in milk
Maternal Levels. A physiologically based pharmacokinetic model predicted that the RID of proguanil is between 0.25% and 0.5%.[2]
Infant Levels. Relevant published information was not found as of the revision date.
“No published information” means the studies do not exist yet — not that Atovaquone and Proguanil is known to be harmful, and not that it is known to be safe. Your prescriber or pharmacist can weigh your baby's age and whether a better-studied alternative would do the same job. Worth asking before stopping a medicine you need.
Source: Drugs and Lactation Database (LactMed), National Institute of Child Health and Human Development (NICHD), via NCBI Bookshelf, record “Atovaquone and Proguanil” (LM592). LactMed on NCBI Bookshelf. LactMed is a registered trademark of the U.S. Department of Health and Human Services.
Educational summary of an authoritative source — not medical advice. Never start, stop, or change a medicine while breastfeeding without confirming with your doctor.