Can you take ketoconazole 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.
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. 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.
Quoted from Ketoconazole — Drugs and Lactation Database (LactMed®), National Institute of Child Health and Human Development, revised May 15, 2023.
What LactMed would consider instead
LactMed ends this record by naming the drugs it would consider in place of ketoconazole. Whether any of them fits depends on what you are treating — this is the database’s list, not a recommendation from us.
How much ketoconazole gets into breastmilk
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.
Infant Levels. Relevant published information was not found as of the revision date.
What has been seen in breastfed infants
A mother taking ketoconazole 200 mg orally for 10 days noticed no adverse effects in her breastfed 1-month-old infant.
Effects on milk supply
Relevant published information was not found as of the revision date.
Frequently asked questions
Can you take ketoconazole while breastfeeding?
What the NIH's Drugs and Lactation Database says about Ketoconazole while breastfeeding — quoted in full. 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 ketoconazole while breastfeeding?
LactMed lists Clotrimazole, Fluconazole, Miconazole, Nystatin 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 ketoconazole pass into breastmilk?
LactMed's measured drug levels for ketoconazole are quoted in full on this page, under "How much gets into breastmilk".
Do I need to pump and dump after taking ketoconazole?
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 ketoconazole
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.