Can you take nifurtimox 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.
Limited information indicates that maternal doses of nifurtimox up to 15 mg/kg daily produce do not cause any adverse serious effects in breastfed infants. Breastmilk levels and a computer simulation found that the dose that an exclusively breastfed infant would receive through breastmilk would be much less than the dose given to treat Chagas disease in newborn infants. Other authors consider that breastfeeding is not contraindicated during the use of nifurtimox.
Quoted from Nifurtimox — Drugs and Lactation Database (LactMed®), National Institute of Child Health and Human Development, revised December 20, 2021.
How much nifurtimox gets into breastmilk
Maternal Levels. A computer simulation using pharmacokinetic data from adults and assuming milk-plasma ratios of 1 resulted in an estimated median infant dose of 0.19% of the maternal weight-adjusted dosage. Assuming milk-plasma ratios of 6 resulted in an estimated maximum infant dose of 3.1% of the maternal weight-adjusted dosage.
Four women with Chagas disease were treated with nifurtimox 10 to 15 mg/kg daily in 3 divided doses provided breastmilk samples for analysis after 4 to 10 days of therapy. The timing of the sample with respect to doses was not reported. Breastmilk concentrations of nifurtimox ranged from nonquantifiable (<0.55 mg/L) to 8.2 mg/L.
Ten women were receiving a median dose of nifurtimox of 9.75 mg/kg daily donated 1 or 2 milk samples at various times after a dose at steady state. The median nifurtimox concentration in milk was 2.15 mg/L (interquartile range 1.32 to 4.55 mg/L). The authors estimated that infants would receive a median daily dosage of 0.5 mg/kg, which is equal to a median weight-adjusted maternal dose of 6.7% (interquartile range 2.35 to 7.19%).
Infant Levels. Relevant published information was not found as of the revision date.
What has been seen in breastfed infants
A cohort of 33 infants who were breastfed (extent not stated) by hospitalized mothers taking nifurtimox was followed in the Democratic Republic of the Congo. Thirty mothers took a full course of 30 doses of oral nifurtimox 15 mg/kg daily and all received 14 doses of intravenous eflornithine 400 mg/kg daily for 7 days for human African trypanosomiasis. (sleeping sickness). Nursing mothers also took a median of 4 other concomitant medications, including amoxicillin, ciprofloxacin, metronidazole, trimethoprim-sulfamethoxazole, aspirin, and diclofenac (1 patient each); hydrocortisone, promethazine and quinine (2 patients each); levamisole (6 patients); sulfadoxine-pyrimethamine (8 patients); dipyrone (13 patients); acetaminophen (16 patients); and mebendazole (17 patients). No serious adverse events were reported in any of the breastfed infants.
Effects on milk supply
Relevant published information was not found as of the revision date.
Frequently asked questions
Can you take nifurtimox while breastfeeding?
Limited information indicates that maternal doses of nifurtimox up to 15 mg/kg daily produce do not cause any adverse serious effects in breastfed infants. 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.
Does nifurtimox pass into breastmilk?
LactMed's measured drug levels for nifurtimox are quoted in full on this page, under "How much gets into breastmilk".
Do I need to pump and dump after taking nifurtimox?
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 nifurtimox
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.