Can you take terbinafine 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 oral maternal doses of 500 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Monitor the infant for jaundice or other signs of liver toxicity, especially in younger, exclusively breastfed infants. Some sources recommend avoiding oral terbinafine during nursing.
Topical terbinafine has not been studied during breastfeeding. Because only about 1% is absorbed after topical application, it is considered a low risk to the nursing infant. Avoid application to the nipple area and ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only water-miscible cream, gel or liquid products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
Quoted from Terbinafine — 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 terbinafine. Whether any of them fits depends on what you are treating — this is the database’s list, not a recommendation from us.
- Ciclopirox
- Efinaconazole
- Tavaborole
How much terbinafine gets into breastmilk
Maternal Levels. A review article states that 2 women excreted totals of 0.7 and 0.2 mg in their milk after a single oral dose of 500 mg of terbinafine. The details of this study were obtained from the manufacturer (Sandoz). Two healthy women aged 32 and 33 years and weighing 57.9 kg and 53.1 kg, respectively, were not breastfeeding, but had some milk production. They were each given four 125 mg tablets of terbinafine after an 8-hour fast. All milk was collected at 6-hour intervals for 72 hours after the dose. The highest concentrations of terbinafine in milk occurred in the first 6-hour aliquot and were 7.3 and 7.9 mg/L, respectively. In the 6- to 12-hour sample, milk concentrations were 2.0 and 2.4 mg/L. In the 12- to 18-hour sample, milk concentrations were 0.15 and 0.25 mg/L. After 18 hours, terbinafine was undetectable (<150 mcg/L[5]) by HPLC assay in milk. The major metabolite of terbinafine was undetectable (<150 mcg/L[5]) by HPLC assay in all aliquots. The cumulative amounts in milk over the 18 hours after the dose were 0.65 mg and 0.15 mg, respectively (noted above as rounded values). Milk production over this time period was 218 mL and 41 mL, respectively. Using the average milk concentration values over the 24-hour period in the 2 subjects, an exclusively breastfed infant would receive 3.8% of the maternal weight-adjusted dosage of terbinafine.
Some package inserts in the U.S. state that milk concentrations of terbinafine are 7-fold maternal plasma concentrations. Communication with the originator U.S. manufacturer, Novartis, indicates that this value was derived from an animal experiment (species not specified). This value is far higher than that found in humans and cannot be considered to be reliable.
Infant Levels. Relevant published information was not found as of the revision date.
What has been seen in breastfed infants
Relevant published information was not found as of the revision date.
Effects on milk supply
Relevant published information was not found as of the revision date.
Frequently asked questions
Can you take terbinafine while breastfeeding?
What the NIH's Drugs and Lactation Database says about Terbinafine 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 terbinafine while breastfeeding?
LactMed lists Ciclopirox, Efinaconazole, Tavaborole 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 terbinafine pass into breastmilk?
LactMed's measured drug levels for terbinafine are quoted in full on this page, under "How much gets into breastmilk".
Do I need to pump and dump after taking terbinafine?
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 terbinafine
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.