Is Itraconazole 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 Itraconazole. 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 clinical use of itraconazole during breastfeeding. However, limited data indicate that maternal itraconazole produces levels in milk that are less than the 5 mg/kg daily doses that have been recommended to treat infants. Until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. If itraconazole is used during breastfeeding, monitoring of the infant’s liver enzymes should be considered, especially with long courses of therapy.
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. An unpublished study reported 2 healthy volunteers who each took 2 oral doses of itraconazole 200 mg 12 hours apart. Milk samples were obtained with a breast pump at 4, 24, and 48 hours after the second dose. The average milk concentrations of itraconazole were 70.2, 27.7, and 16.2 mcg/L, respectively. At 72 hours, the milk level was 20.1 mcg/L in one woman and not detectable (<5 mcg/L) in the other. However, steady-state was probably not attained at the time of sampling, and metabolites including the active hydroxyitraconazole were not measured.[1]
Using data reported in the literature, including the above source, researchers estimated that fully breastfed infants between 3 and 12 months of age would receive 1.48% of the mother's weight-adjusted dosage of itraconazole and attain a plasma concentration of 0.77% of the mother's plasma concentration.[2]
Infant Levels. Relevant published information was not found as of the revision date.
Alternatives LactMed lists
“No published information” means the studies do not exist yet — not that Itraconazole 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 “Itraconazole” (LM1010). 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.