Is Fluconazole 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 Fluconazole. The text below is quoted from that source — it is not our own verdict.
Summary of use during breastfeeding
Fluconazole is acceptable in nursing mothers because amounts excreted into breastmilk are less than the neonatal fluconazole dosage.[1] Although no adequate clinical studies on fluconazole in Candida mastitis have been published, a survey of members of the Academy of Breastfeeding Medicine found that fluconazole is often prescribed for nursing mothers to treat breast candidiasis, especially with recurrent or persistent infections.[2] Treatment of the mother and infant simultaneously with fluconazole is often used when other treatments fail.[2-5] The most common maternal dosage regimen is 400 mg once, followed by 200 mg daily for at least 2 weeks or until pain is resolved,[6,7] although a study in Australia used a dose of 150 mg every other day until breast pain resolved.[8] The dosage of fluconazole in breastmilk with these maternal dosages is not sufficient to treat oral thrush in the infant.
Effects on the breastfed infant
In a study of fluconazole for treatment of lactation-associated thrush of the breasts, mothers took an average of 7.3 capsules (range 1 to 29 capsules) of 150 mg every other day until pain resolved. Seven of the 96 women reported side effects possibly caused by fluconazole in their breastfed infants. These included flushed cheeks, gastrointestinal upset, and runny or mucous stools.[8]
Effects on milk supply
Relevant published information was not found as of the revision date.
Levels in milk
Maternal Levels. A woman taking fluconazole 200 mg orally once daily for 18 days had a peak milk level of 4.1 mg/L 2 hours after the dose on day 20 postpartum. The half-life of elimination from breastmilk was 26.9 hours.[9]
A 12-week postpartum woman was given a single oral dose of fluconazole 150 mg. The highest milk levels were 2.9 and 2.7 mg/L at 2 and 5 hours after the dose. Milk fluconazole levels were 1.8 and 1 mg/L at 24 and 48 hours after the dose, respectively. The half-life in milk was about 30 hours.[10]
Using peak milk level data from these two patients, an exclusively breastfed infant whose mother was taking 200 mg daily of fluconazole would receive a maximum of about 0.6 mg/kg daily, which is 60% of the recommended neonatal (<2 weeks) dosage and 20% of the dosage used in older infants for oral thrush.
Infant Levels. Relevant published information was not found as of the revision date.
Alternatives LactMed lists
Fluconazole in pregnancy
LactMed covers breastfeeding only. For what the NHS and the US prescribing label say about pregnancy, see:
Source: Drugs and Lactation Database (LactMed), National Institute of Child Health and Human Development (NICHD), via NCBI Bookshelf, record “Fluconazole” (LM357). 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.