Miconazole and Breastfeeding

Summary of use during lactation

Because miconazole has poor absorption from the skin and vagina and has poor oral bioavailability, it is unlikely to adversely affect the breastfed infant, including after topical application to the nipples. However, miconazole ointment appears to have no advantage over lanolin for treating sore nipples during breastfeeding and a survey of members of the Academy of Breastfeeding Medicine found topical miconazole is rarely prescribed to nursing mothers to treat thrush.[1,2] Any excess cream or ointment should be removed from the nipples before nursing. 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. Relevant published information was not found as of the revision date. Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

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

Effects on lactation and breastmilk

In a randomized, double-bind trial, lanolin was compared to an all-purpose nipple ointment containing mupirocin 1%, betamethasone 0.05%, and miconazole 2% for painful nipples while nursing in the first 2 weeks postpartum. The two treatments were equally effective in reducing nipple pain, nipple healing time, breastfeeding duration, breastfeeding exclusivity rate, mastitis and nipple symptoms, side effects or maternal satisfaction with treatment.[1]

Alternative drugs to consider

Clotrimazole, Fluconazole, Nystatin

References

1. DennisCL SchottleN HodnettE An all-purpose nipple ointment versus lanolin in treating painful damaged nipples in breastfeeding women: A randomized controlled trial. Breastfeed Med 2012 7 473 9 22428572 PubMed
2. BrentNB Thrush in the breastfeeding dyad: Results of a survey on diagnosis and treatment. Clin Pediatr (Phila) 2001 40 503 6 11583049 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