Is topical Lotrisone (clotrimazole/betamethasone) safe during breastfeeding?

From the Guidelines

Topical Lotrisone (clotrimazole/betamethasone) should be used with caution during breastfeeding, as the betamethasone component may be absorbed systemically and potentially affect milk production or expose the infant to small amounts of corticosteroid. While the clotrimazole component is considered safe during breastfeeding, the betamethasone component is a potent corticosteroid that may pose risks, especially with prolonged or large-area use 1. If used, apply sparingly only to affected areas, avoid application on or near the breasts, wash hands thoroughly after application, and ensure the medication is completely dry before breastfeeding to minimize infant exposure. For breastfeeding mothers, consider alternatives such as clotrimazole-only products for fungal infections when possible. The concern with betamethasone stems from potential systemic absorption, though the risk is minimal with limited, short-term use on small areas 1. Some guidelines suggest that topical corticosteroids can be safely continued during pregnancy and in the postdelivery period, if needed, but this does not directly address breastfeeding safety 1. However, given the potential risks, it is essential to discuss with your healthcare provider about the most appropriate option based on the location and severity of the infection. Moisturizers, which can be used in conjunction with or as an alternative to topical corticosteroids for some conditions, are considered safe during lactation 1. Ultimately, the decision to use topical Lotrisone during breastfeeding should be made with caution and under the guidance of a healthcare provider, weighing the benefits against the potential risks to both the mother and the infant.

From the FDA Drug Label

It is not known whether topical administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in breast milk. Systemically administered corticosteroids are secreted into breast milk in quantities not likely to have a deleterious effect on the infant Nevertheless, caution should be exercised when topical corticosteroids are administered to a nursing woman.

The use of topical Lotrisone (clotrimazole/betamethasone) during breastfeeding is not entirely clear, but caution is advised. Since it is not known whether topical administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in breast milk, it is recommended to exercise caution when using topical corticosteroids, including Lotrisone, in nursing women 2.

From the Research

Topical Lotrisone Safety During Breastfeeding

• The safety of topical Lotrisone (clotrimazole/betamethasone) during breastfeeding is not directly addressed in the provided studies.
• However, general principles of drug transfer into breast milk can be applied:
  • According to 3, most commonly used drugs are relatively safe for breastfed babies, with the dose received via milk being generally small.
  • 4 states that the transfer of medications into breast milk depends on a concentration gradient, allowing passive diffusion of nonionized, non-protein-bound drugs.
• Topical therapy, like Lotrisone, is mentioned in 4 as a way to limit infant exposure to medications, as it is poorly absorbed orally.
• While there is no specific information on the safety of topical Lotrisone during breastfeeding, the general consensus is that topical treatments are preferred to minimize exposure to the infant.
• It is essential to consult with a healthcare professional or a reliable resource, such as those mentioned in 3 and 4, for personalized advice on medication use during breastfeeding.