Can you take fluconazole while breastfeeding?
What LactMed says
The National Library of Medicine’s own summary, quoted in full. We do not write a verdict of our own on this question, and we do not compress theirs into a label.
Fluconazole is acceptable in nursing mothers because amounts excreted into breastmilk are 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. The most common maternal dosage regimen is 400 mg once, followed by 200 mg daily for at least 2 weeks or until pain is resolved, although a study in Australia used a dose of 150 mg every other day until breast pain resolved. The dosage of fluconazole in breastmilk with these maternal dosages is not sufficient to treat oral thrush in the infant.
Quoted from Fluconazole — Drugs and Lactation Database (LactMed®), National Institute of Child Health and Human Development, revised October 15, 2024.
What LactMed would consider instead
LactMed ends this record by naming the drugs it would consider in place of fluconazole. Whether any of them fits depends on what you are treating — this is the database’s list, not a recommendation from us.
How much fluconazole gets into breastmilk
Maternal Levels. A woman taking fluconazole 200 mg orally once daily for 18 days had a peak milk level of 4.1 mg/L 2 hours after the dose on day 20 postpartum. The half-life of elimination from breastmilk was 26.9 hours.
A 12-week postpartum woman was given a single oral dose of fluconazole 150 mg. The highest milk levels were 2.9 and 2.7 mg/L at 2 and 5 hours after the dose. Milk fluconazole levels were 1.8 and 1 mg/L at 24 and 48 hours after the dose, respectively. The half-life in milk was about 30 hours.
Using peak milk level data from these two patients, an exclusively breastfed infant whose mother was taking 200 mg daily of fluconazole would receive a maximum of about 0.6 mg/kg daily, which is 60% of the recommended neonatal (<2 weeks) dosage and 20% of the dosage used in older infants for oral thrush.
Infant Levels. Relevant published information was not found as of the revision date.
What has been seen in breastfed infants
In a study of fluconazole for treatment of lactation-associated thrush of the breasts, mothers took an average of 7.3 capsules (range 1 to 29 capsules) of 150 mg every other day until pain resolved. Seven of the 96 women reported side effects possibly caused by fluconazole in their breastfed infants. These included flushed cheeks, gastrointestinal upset, and runny or mucous stools.
Effects on milk supply
Relevant published information was not found as of the revision date.
Frequently asked questions
Can you take fluconazole while breastfeeding?
Fluconazole is acceptable in nursing mothers because amounts excreted into breastmilk are less than the neonatal fluconazole dosage. The full record is quoted on this page, and the decision is one to make with the person who prescribed it — LactMed itself states it is not a substitute for professional judgement.
What can I take instead of fluconazole while breastfeeding?
LactMed lists Clotrimazole, Miconazole as alternate drugs to consider. That is the database's own list for this drug — whether any of them suits you depends on what you are treating.
Does fluconazole pass into breastmilk?
LactMed's measured drug levels for fluconazole are quoted in full on this page, under "How much gets into breastmilk".
Do I need to pump and dump after taking fluconazole?
LactMed does not frame its records that way — it reports measured drug levels in milk and what has been observed in breastfed infants, which is what this page quotes. "Pump and dump" advice for a specific drug and dose should come from your clinician or a pharmacist, not from a general rule.
More on fluconazole
LactMed states that the information it presents is not a substitute for professional judgement, and that you should consult your healthcare provider for breastfeeding advice related to your particular situation. Nothing on this page is medical advice.