Ketoconazole and Breastfeeding

Summary of use during lactation

Because there is little published experience with ketoconazole or levoketoconazole during breastfeeding and its potential liver enzyme inhibition and liver toxicity, other agents are preferred. The manufacturers recommend that mothers taking ketoconazole or levoketoconazole avoid breastfeeding during treatment and for 1 day after the last dose. Use of ketoconazole shampoo or topical use on the skin by the mother poses little to no risk to the breastfed infant.[1,2] However, topical use on the breast or nipples should be avoided in nursing mothers because of possible oral ingestion by the infant and the availability of safer alternatives. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.[3]

Drug levels in milk and infant serum

Maternal Levels. A mother who was 1 month postpartum took ketoconazole 200 mg orally for 10 days. A peak ketoconazole milk level of 220 mcg/L occurred 3.25 hours after the dose and the average milk level was 68 mcg/L. The authors calculated that an exclusively breastfed infant would ingest an average of 0.01 mg/kg daily or about 0.4% of the maternal weight-adjusted dosage and a maximum of 0.033 mg/kg daily or about 1.4% of the maternal weight-adjusted dosage.[4] Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

A mother taking ketoconazole 200 mg orally for 10 days noticed no adverse effects in her breastfed 1-month-old infant.[4]

Effects on lactation and breastmilk

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

Alternative drugs to consider

Clotrimazole, Fluconazole, Miconazole, Nystatin

References

1. Mactal-HaafC HoffmanM KuchtaA Use of anti-infective agents during lactation, Part 3: Antivirals, antifungals, and urinary antiseptics. J Hum Lact 2001 17 160 6 11847833 PubMed
2. LeachmanSA ReedBR The use of dermatologic drugs in pregnancy and lactation. Dermatol Clin 2006 24 167 97 16677965 PubMed
3. NotiA GrobK BiedermannM Exposure of babies to C(15)-C(45) mineral paraffins from human milk and breast salves. Regul Toxicol Pharmacol 2003 38 317 25 14623482 PubMed
4. MorettiME ItoS KorenG Disposition of maternal ketoconazole in breast milk. Am J Obstet Gynecol 1995 173 1625 6 7503214 PubMed