Norfloxacin and Breastfeeding

Summary of use during lactation

No information is available on the clinical use of norfloxacin during breastfeeding; however, amounts in breastmilk appear to be low. Fluoroquinolones such as norfloxacin have traditionally not been used in infants because of concern about adverse effects on the infants' developing joints. However, more recent studies indicate little risk.[1,2] In addition, the calcium in milk might prevent absorption of the small amounts of fluoroquinolones in milk,[3] but insufficient data exist to prove or disprove this assertion. The serum and milk levels and oral bioavailability of norfloxacin are the lowest of any of the fluoroquinolones, so the risk to the infant should be minimal. Use of norfloxacin is acceptable in nursing mothers with monitoring of the infant for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash).

Drug levels in milk and infant serum

Maternal Levels. Norfloxacin was undetectable in milk at any time up to 6 hours after a single 200 mg oral dose.[4] Milk levels have not been measured after repeated administration. 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

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

Alternative drugs to consider

Ciprofloxacin, Levofloxacin, Nitrofurantoin, Trimethoprim

References

1. van den Oever HL, Versteegh FG, Thewessen EA, et al. Ciprofloxacin in preterm neonates: Case report and review of the literature. Eur J Pediatr 1998;157:843-59809826 PubMed
2. Gürpinar AN, Balkan E, Kiliç N, et al. The effects of a fluoroquinolone on the growth and development of infants. J Int Med Res 1997;25:302-69364293 PubMed
3. Fleiss PM. The effect of maternal medications on breast-feeding infants. J Hum Lact 1992;8:71558663 PubMed
4. Takase Z, Shirafuji H, Uchida M. Basic and clinical studies on AM-715 in the field of obstetrics and gynecology. Chemotherapy (Tokyo) 1981;29 (Suppl 4):697-704