From the Guidelines
Antifungal Treatments During Pregnancy
Topical antifungal treatments such as clotrimazole and miconazole are considered safe for use during pregnancy, typically for 2-4 weeks 1. For systemic infections, fluconazole (150 mg single dose) is recommended for vaginal candidiasis, while itraconazole (100-200 mg/day for 3-6 months) may be used for other fungal infections under close medical supervision 1. However, high-dose fluconazole (>400 mg/day) and other systemic antifungals like voriconazole and posaconazole are generally avoided due to potential fetal risks 1.
- Topical treatments: clotrimazole, miconazole, butoconazole, and terconazole are safe for use during pregnancy 1.
- Systemic treatments: fluconazole (low dose) and itraconazole may be used under close medical supervision, while high-dose fluconazole, voriconazole, and posaconazole are avoided due to potential fetal risks 1.
- Amphotericin B: may be used as an alternative to azole antifungals during pregnancy, especially in the first trimester 1.
It is essential to weigh the benefits and risks of antifungal treatment during pregnancy and to use the lowest effective dose for the shortest duration necessary to minimize potential fetal risks 1.
From the FDA Drug Label
Use in pregnancy should be avoided except in patients with severe or potentially life-threatening fungal infections in whom fluconazole may be used if the anticipated benefit outweighs the possible risk to the fetus A few published case reports describe a pattern of distinct congenital anomalies in infants exposed in utero to high dose maternal fluconazole (400 to 800 mg/day) during most or all of the first trimester. Spontaneous abortions and congenital abnormalities have been suggested as potential risks associated with 150 mg of fluconazole as a single or repeated dose in the first trimester of pregnancy based on retrospective epidemiological studies.
Safe antifungal treatments during pregnancy are not explicitly stated in the label, but it can be inferred that:
- Fluconazole may be used in severe or potentially life-threatening fungal infections if the anticipated benefit outweighs the possible risk to the fetus.
- The label does not provide information on other antifungal treatments that are safe during pregnancy.
- The use of fluconazole during pregnancy should be approached with caution due to the potential risk of congenital anomalies and spontaneous abortions. 2
From the Research
Antifungal Treatments During Pregnancy
There are limited studies on the safety of antifungal treatments during pregnancy. However, some antifungal agents have been used in pregnant women with caution.
- Nystatin and amphotericin B have been used to treat fungal infections in pregnant women, but their safety and efficacy have not been extensively studied 3.
- Fluconazole has been used to treat vaginal candidiasis in pregnant women, but its use should be limited to cases where the benefits outweigh the risks 4.
- Itraconazole has been used to treat fungal infections in non-pregnant women, but its safety during pregnancy has not been established 5.
- There is no evidence to support the use of dehydroepiandrosterone (DHEA) as an antifungal treatment during pregnancy, as it is not an antifungal agent and its effects on pregnancy are not well understood 6.
Safety Considerations
When using antifungal treatments during pregnancy, it is essential to consider the potential risks and benefits.
- The use of antifungal agents during pregnancy should be limited to cases where the benefits outweigh the risks.
- Pregnant women should be closely monitored for adverse effects and fetal development.
- The choice of antifungal agent should be based on the type and severity of the fungal infection, as well as the gestational age of the pregnancy.
Available Antifungal Agents
The following antifungal agents have been mentioned in the studies: