Fluconazole (Diflucan) and Breastfeeding
Fluconazole is safe and compatible with breastfeeding, making it the preferred azole antifungal for nursing mothers. 1
Primary Recommendation
Breastfeeding mothers can safely continue nursing while taking fluconazole without interruption. 1, 2 The Infectious Diseases Society of America (IDSA) explicitly states that breastfeeding is not recommended for mothers on azole antifungals other than fluconazole, clearly distinguishing fluconazole as the safe exception among this drug class. 1
Evidence Supporting Safety
The American Academy of Pediatrics considers fluconazole compatible with breastfeeding, providing the highest level of guideline support. 1, 3, 4
Fluconazole is excreted in breast milk at concentrations similar to plasma, but the estimated daily infant dose from breast milk is only approximately 13% of the recommended pediatric dose for oropharyngeal candidiasis. 5
After a single 150 mg dose, peak milk concentration was 2.61 mcg/mL at 5.2 hours post-dose, resulting in an estimated infant exposure of 0.39 mg/kg/day—well below therapeutic pediatric dosing. 5
A published survey of 96 breastfeeding women treated with fluconazole 150 mg every other day (average 7.3 capsules) reported no serious adverse reactions in infants. 5
Clinical Context and Dosing
For breast and nipple thrush (candidal mastitis), typical regimens range from 150-400 mg loading dose followed by 100-200 mg daily for 2+ weeks. 2, 6, 7
Most women with breast thrush require 6 or more fluconazole capsules (150 mg each) for complete symptom resolution, with a range of 1-29 capsules in clinical studies. 7
Fluconazole has an excellent safety profile in infants and is routinely used to treat fungal infections in neonates and children, further supporting its safety during breastfeeding. 5, 2
Comparison with Other Antifungals
Itraconazole, posaconazole, and voriconazole should be avoided during breastfeeding, as they lack safety data and carry potential toxicity concerns. 1, 4
Topical options like miconazole and nystatin are classified as "compatible" with breastfeeding and may be used for localized nipple infections, though excess cream should be removed before nursing. 1, 3
Important Caveats
High-dose fluconazole (400-800 mg/day) during the first trimester of pregnancy is associated with congenital malformations, but this pregnancy concern does not apply to breastfeeding, where the drug is considered safe. 1, 5
Fluconazole concentrations in breast milk remain relatively constant across doses, and the drug's long half-life (31-37 hours) means steady-state levels are achieved with repeated dosing. 8
No interruption of breastfeeding is necessary at any fluconazole dose used for maternal fungal infections. 2