Is Sulfisoxazole safe while breastfeeding?

Summary of use during breastfeeding

With healthy, fullterm infants it appears acceptable to use sulfisoxazole during breastfeeding after the newborn period.[1,2] Until further data are accumulated, alternate agents should probably be used in jaundiced, ill, stressed or premature infants, because of the risk of bilirubin displacement and kernicterus. Sulfisoxazole should be avoided while breastfeeding a glucose-6-phosphate dehydrogenase (G6PD) deficient infant.

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. Following oral sulfisoxazole doses of 1 g every 6 hours for 4 doses to 6 women (time postpartum not stated), an average total recovery of sulfisoxazole and N4-acetylsulfisoxazole of 18 mg was obtained during the 48 hours from the time of the first dose. About 77% of the drug in milk was recovered as the metabolite. This averaged 0.45% of the maternal dose (not weight-adjusted).[3] This study may have underestimated the amount excreted by a small fraction, because steady-state metabolite serum levels were not achieved during the study period.[1,4]

Infant Levels. A 9-month-old infant was breastfed twice daily during maternal treatment for a urinary tract infection (dosage not stated). Urine was collected during a 24-hour time period from the infant. The infant excreted 1.1 mg of sulfisoxazole plus N4-acetylsulfisoxazole over the time period.[3]

Alternatives LactMed lists

• Sulfamethoxazole
• Trimethoprim-Sulfamethoxazole