Is Cipro (ciprofloxacin) Dex (dexamethasone) ear drops safe for use in breastfeeding mothers?

Ciprodex (Ciprofloxacin/Dexamethasone) Ear Drops and Breastfeeding

Ciprodex ear drops are safe to use during breastfeeding because the systemic absorption from topical otic administration is minimal, resulting in negligible infant exposure through breast milk.

Evidence from FDA Drug Label

The FDA label for ciprofloxacin/dexamethasone otic suspension directly addresses breastfeeding safety:

• Systemic absorption after topical otic administration is extremely low, with peak plasma concentrations of ciprofloxacin averaging only 1.39 ng/mL (approximately 0.1% of levels achieved with a 250 mg oral dose) 1
• The FDA label explicitly states that "because of the minimal systemic absorption of ciprofloxacin following topical otic administration of ciprofloxacin and dexamethasone otic suspension, breastfeeding is not expected to result in the exposure of the infant to ciprofloxacin" 1
• While systemically administered corticosteroids appear in human milk, it is unknown whether topical otic administration results in sufficient systemic absorption to produce detectable quantities of dexamethasone in breast milk 1

Clinical Context: Systemic vs. Topical Administration

The concerns about fluoroquinolones during breastfeeding primarily relate to systemic (oral or IV) administration, not topical ear drops:

• Fluoroquinolones have theoretical concerns based on cartilage damage in animal studies, but these fears have not been confirmed in human pregnancy or breastfeeding exposure data 2
• Even systemic ciprofloxacin use during breastfeeding appears safe, with studies reporting no substantial increase in osteoarticular toxicity despite theoretical concerns 3
• When fluoroquinolones are systemically indicated during breastfeeding, ciprofloxacin is the preferred agent within this class 4

Practical Recommendation

• Continue breastfeeding without interruption while using Ciprodex ear drops 1
• No need to "pump and dump" or time breastfeeding sessions around medication administration 1
• The combination of minimal systemic absorption from otic route plus the already-low transfer of ciprofloxacin to breast milk makes infant exposure essentially negligible 1, 3

Important Caveat

• This recommendation applies specifically to otic (ear) use only - the product must never be used in the eye or administered systemically 1
• Topical medications have significantly less systemic absorption compared to oral medications, which is the key safety factor here 5