Spironolactone Safety During Lactation
Spironolactone is compatible with breastfeeding, with minimal risk to the infant. 1
Guideline Recommendation
The Journal of the American Academy of Dermatology guidelines explicitly state that spironolactone is "compatible with breastfeeding; risk to infant is minimal" in their comprehensive dosing and safety table. 1
Drug Transfer and Infant Exposure
Spironolactone itself does not transfer into breast milk. 2 According to FDA labeling:
- Spironolactone is not present in breast milk 2
- Only the active metabolite canrenone appears in breast milk in low amounts that are clinically inconsequential 2
- Limited data from a lactating woman at 17 days postpartum showed no adverse effects in the breastfed infant after short-term exposure 2
Clinical Considerations
The decision to use spironolactone during lactation should weigh the developmental and health benefits of breastfeeding against the mother's clinical need for the medication. 2 Key factors include:
- No adverse effects have been reported in breastfed infants with short-term maternal use 2
- Long-term effects on breastfed infants remain unknown 2
- The extremely low levels of the metabolite in breast milk make clinically significant infant exposure unlikely 2
Important Caveats
While spironolactone is considered safe during lactation, it carries pregnancy category C and should be avoided during pregnancy due to potential feminization of male fetuses at high doses in animal studies. 1, 2 Patients should be counseled about contraception if they are of childbearing age and not exclusively breastfeeding, as lactational amenorrhea is not reliable contraception.