Fluconazole

Drug Levels and Effects:




Summary of Use during Lactation:


Fluconazoleis acceptable in nursing mothers because amounts excreted into breastmilk are less than the neonatal fluconazole dosage. 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.[1] Treatment of the mother and infant simultaneously with fluconazole is often used when other treatments fail.[1][2][3][4] A dosage of 200 mg daily for 2 weeks is often recommended,[5] although a study in Australia used a dose of 150 mg every other day until breast pain resolved.[6] The dosage of fluconazole in breastmilk with a maternal dosage of 200 mg daily is not sufficient to treat oral thrush in the infant.


Drug Levels:


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.[7]

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.[8]

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.


Effects in Breastfed Infants:


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.[6]


Possible Effects on Lactation:


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


Alternate Drugs to Consider:


Clotrimazole,Miconazole


References:


1. Brent NB. Thrush in the breastfeeding dyad: results of a survey on diagnosis and treatment. Clin Pediatr (Phila). 2001;40:503-6. PMID:11583049
2. Bodley V, Powers D. Long-term treatment of a breastfeeding mother with fluconazole -resolved nipple pain caused by yeast: a case study. J Hum Lact. 1997;13:307-11. PMID:9429366
3. Chetwynd EM, Ives TJ, Payne PM et al.Fluconazolefor postpartum candidal mastitis and infant thrush. J Hum Lact. 2002;18:168-71. PMID:12033079
4. Betzold CM. Results of microbial testing exploring the etiology of deep breast pain during lactation: A systematic review and meta-analysis of nonrandomized trials. J Midwifery Womens Health. 2012;57:353-64. PMID:22758357
5. Hanna L, Cruz SA. Candida mastitis: a case report. Perm J. 2011;15:62-4. PMID:21505621
6. Moorhead AM, Amir LH, O'Brien PW, Wong S. A prospective study of fluconazole treatment for breast and nipple thrush. Breastfeed Rev. 2011;19:25-9. PMID:22263374
7. Schilling CG, Seay RE, Larson TA et al. Excretion of fluconazole in human breast milk. Pharmacotherapy. 1993;13:287. Abstract.
8. Force RW.Fluconazoleconcentrations in breast milk. Pediatr Infect Dis J. 1995;14:235-6. PMID:7761190



Substance Identification:




Substance Name:

Fluconazole

CAS Registry Number:

86386-73-4

Drug Class:


  • Antifungal Agents


  • Administrative Information:




    LactMed Record Number:


    357


    Last Revision Date:


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