Please only answer if you have used diflucan before. Thanks.
OK i’m obviously about it ignore you as i have never used diflucan but i am asking what doctor said it was ok VS not? if your pediatrician said no, i would go with their advice as they are more focused on the baby where a general practitioner is more focused on you… again while i didn’t have diflucan i was told that my meds for psoriasis was ok by my ob but not ok by my baby’s pediatrician… so i went with what the ped said since i figured they were more focused on the baby… you can also check safefetus.com they list different drugs and the categories they fall into and whether or not the are transferred during BF
tons of meds can cause liver damage to baby. always look up the med yourself at web md or fda.com
if one doctor says no and you take it and something happens could you ever forgive yourself?
yes it is safe, take as perscribe and the infection should clear up.
I was given a whopping 21-day course of diflucan to try to knock out a systemic thrush infection that wouldn’t respond to anything else. My daughter was only a few weeks old at the time. (It took us a few weeks to diagnose the infection and try all the other cures.) Anyway, both her pediatrician, my OB, and the lactation consultant said it was OK.
Its AAP approved. Its used to treat infants directly. Its approved by Hale. What more do you want? Many doctors say many meds are unsafe during lactation because they do not know and can’t be bothered to find out or worse figure they are less likely to be sued over the side effects of formula over the side effects of a medication.
Its not necessarily my first choice for treatment (grapefruit seed extract, probiotics, and dietary changes are my first choice) but its one of the better treatments for severe problems. [see: Identifying and Treating Thrush http://www.drjaygordon.com/development/bf/thrush.asp ]
Generic name Fluconazole [more]
Trade Name Diflucan
AAP approved?* Approved
Pregnancy Risk Category** C
Lactation Risk Category* *L2
Drug Levels and Effects:
Summary of Use during Lactation:
Fluconazole is excreted into breastmilk in amounts that are larger than many other drugs, but 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. Treatment of the mother and infant simultaneously with fluconazole is often used when other treatments fail.
Because the levels in breastmilk are less than those given to infants, fluconazole is acceptable in nursing mothers. However, the dosage in breastmilk with a maternal dosage of 200 mg daily is not sufficient to treat oral thrush in the infant.
* Excreted into milk.
* Probably safe to use during breast feeding and can be used in infants with disseminated candida infection.
Treating Candida Infections
Our first approach to treating these infections is gentian violet (handout #6 Using Gentian Violet) plus all purpose nipple ointment and sometimes grapefruit seed extract (see handout #3b Treatments for Sore Nipples and Sore Breasts and Handout C: Candida Protocol). This approach is safe, works rapidly, and almost always, though there seems to have been a decrease in the effectiveness of gentian violet over the past few years. For this reason, I now use the combination of the ointment and the gentian violet as well as the grapefruit seed extract. A good response to gentian violet confirms that the mother’s nipple pain is caused by Candida since little else will respond to gentian violet. It thus also justifies the use of fluconazole, if needed. Even if the above treatment does not help, fluconazole should not be used alone to treat sore nipples and should be added to treatment on the nipples, not used instead. I have not found nystatin to be particularly useful either in treatment of the baby’s mouth or in the treatment of the mother’s nipples. Clotrimazole cream alone is also not particularly effective in my opinion, but others obviously feel differently.
Fluconazole is an antifungal agent that is taken systemically (by mouth or intravenously). It stops fungi (such as Candida albicans) from multiplying, but does not actually kill them. This accounts for the fact that sometimes it takes several days to have an effect. Fluconazole powder is also available and can be mixed with the all purpose nipple ointment instead of miconazole powder.
Fluconazole is generally well tolerated, but there is no such thing as a drug that never has side effects. Concern about liver injury is exaggerated, since this complication seems quite rare, and usually occurs in people who are taking other medications as well, and who have taken fluconazole for months or longer, and who have immune deficiencies. But it is a possibility that needs to be kept in mind and if it does occur, it can be very serious.
Vomiting, diarrhea, abdominal pain and skin rashes are the most common side effects. These are not usually severe, and only occasionally is it necessary to stop the medication because of these side effects. Allergic reactions are possible but uncommon. Call or email immediately if you have any concerns.
Fluconazole in the milk
Fluconazole does appear in the milk, and this is as it should be, since the idea is to treat infection in the ducts and nipples. It is thus superior to ketoconazole, which gets into the milk in only tiny amounts. The baby will obviously get some, but this drug is now being promoted for use in babies for the treatment of simple thrush. There have been no complications in the baby reported from exposure to fluconazole in the breastmilk. Continue breastfeeding while taking fluconazole, even if you are told that you should stop.
When it comes to questions about what may or may not be safe for their baby, women who are pregnant, planning a pregnancy, or breastfeeding turn to Motherisk – Canada’s expert on the safety of medications, infections, chemicals, personal products and everyday exposures during pregnancy and breastfeeding.
(416) 813-6780 – Monday to Friday, 9-5 EST Call from ANYWHERE in the world!
Infants who are formula fed are at risk for more short- and long-term health problems than are their breastfed peers (Table 1). The American Academy of Pediatrics (AAP, 1997) recommends exclusive breastfeeding for approximately the first 6 months of life, and continued breastfeeding to at least 1 year or beyond. Formula-fed infants have more allergies and incidents of asthma and wheezing (Burr et al, 1993), more episodes of diarrhea (Clemens et al, 1999), more ear infections (Duffy, Faden, Wasielewski, Wolf, & Krystofik, 1997), and are more likely to be overweight or obese entering kindergarten (Armstrong & Reilly, 2001). Children who were not breastfed as infants are at increased risk for developing childhood cancers (Davis, 1998) and type 1 insulin-dependent diabetes (Virtanen et al., 1991).
If a mother chooses (or is advised) to formula-feed, her health is at risk, too, both in the postpartum period and in the long term. Not breastfeeding increases the risk of postpartum bleeding, and women who do not breastfeed also have a greater incidence of obesity and osteoporosis later in life (Lawrence & Lawrence, 1999). Mothers who do not breastfeed significantly increase their risk of ovarian cancer (Lawrence & Lawrence), and a recent large -scale reanalysis of data from 47 different studies (including more than 500 ,0 000 women) found that mothers decreased their risk of breast cancer by 4.3% for every 12 months they breastfed (Collaborative Group, 2002). Mothers who do not breastfeed miss out on important mother -infant bonding and the empowerment many mothers find in being able to provide something positive and special for their babies (Lawrence & Lawrence). In other words, not only is “breast best,” breast is normal.
Breastfeeding and Psychotropic Drugs: General Considerations in the Healthy Full -Term Infant
Many healthcare providers know little about the effects on the infant of drugs in breast milk, and fear possible harmful effects if a drug is known to have an unfavorable pregnancy category rating. However, whereas drugs present in maternal plasma during pregnancy can pass directly to the fetus through the placenta, the breast is much more selective. Most drugs do pass into breast milk, but almost all appear in only small amounts-less than 1% of the maternal dosage. Very few medications are actually contraindicated in breastfeeding women (Riordan & Auerbach, 1999). To better understand factors that affect drug transfer and concentration in breast milk, see Table 2.
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