Doxycycline Safety in Nursing Mothers
Doxycycline is considered acceptable for short-term use in nursing mothers as tetracyclines are present only in very low levels in breast milk, and the calcium in breast milk might inhibit absorption by infants. 1
Safety Profile in Lactation
- Tetracyclines, including doxycycline, are excreted in human milk; however, the extent of absorption by the breastfed infant is not known 2
- Short-term use of doxycycline as recommended for treatment is considered probably safe during lactation based on available literature and expert opinion 1
- The American Academy of Pediatrics Committee on Drugs lists tetracycline as "usually compatible with breastfeeding" 1
- Tetracyclines are present only in very low levels in breast milk, and calcium in breast milk might inhibit absorption by infants 1
Clinical Evidence Supporting Safety
- One study of mothers on a steady state dose of tetracycline found that it reached a peak breast milk concentration of only 2.58 mg/L and was undetectable in the serum of their breastfeeding infants 1
- Because of the low concentrations of all tetracyclines found in breast milk, significant adverse reactions in nursing infants are unlikely 1
- Doxycycline is now considered acceptable for short-term use even in children aged <8 years, which further supports its safety profile during breastfeeding 1
Recommendations for Use
- Doxycycline should only be prescribed for short-term use with avoidance of repeated courses in nursing mothers 1
- The FDA drug label states that short-term use by lactating women is not necessarily contraindicated, though effects of prolonged exposure to doxycycline in breast milk are unknown 2
- A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother if long-term therapy is needed 2
Special Considerations
- Minocycline (another tetracycline) has been associated with black discoloration of breast milk believed to be caused by iron pigment deposition in macrophages, which might be worrisome to patients 1
- If a nursing mother requires tetracycline treatment, doxycycline may be preferred over other tetracyclines due to its better safety profile 1
- For life-threatening conditions like Rocky Mountain Spotted Fever, the benefits of doxycycline treatment clearly outweigh potential risks 1
Alternative Antibiotics
- If there are concerns about using doxycycline, alternative antibiotics may be considered depending on the indication:
- Fluoroquinolones (ciprofloxacin, ofloxacin) are present in breast milk in quantities far below the usual pediatric dosage 1
- Aminoglycosides are poorly absorbed by the gastrointestinal tract and present in breast milk in very low quantities 1
- Trimethoprim-sulfamethoxazole is found in very low levels in breast milk but should be avoided in infants aged ≤28 days and those with pre-existing jaundice, prematurity, or glucose-6-phosphate deficiency 1