Itraconazole Safety During Breastfeeding

Evidence on Itraconazole in Breast Milk

• Itraconazole is excreted in breast milk, with the amount present being less than the neonatal dosage 1, 2
• The drug is poorly absorbed orally, which reduces potential exposure to the breastfed infant 1

Recommendations for Breastfeeding Mothers

• The American Academy of Pediatrics considers fluconazole compatible with breastfeeding, whereas itraconazole is not recommended for breastfeeding mothers 3, 4
• The European Respiratory Society/Thoracic Society of Australia and New Zealand (ERS/TSANZ) task force classifies itraconazole as "possibly safe" during breastfeeding, but notes there is limited information available in nursing mothers 1, 2

Comparison with Other Antifungals

• The American Academy of Pediatrics explicitly states that fluconazole is compatible with breastfeeding, making it a preferable option to itraconazole 3, 4
• Nystatin is classified as "compatible" with breastfeeding, though any excess cream should be removed from nipples before nursing 1
• Posaconazole and voriconazole should be avoided during breastfeeding due to potential toxicity concerns and lack of safety data 1, 3

Clinical Considerations and Monitoring

• Consider the severity of the maternal fungal infection when weighing risks versus benefits of itraconazole therapy during breastfeeding 3

Important Caveats

• Itraconazole may accumulate in breast milk over time with prolonged use 3