Can I take Itraconazole while breastfeeding my baby?

Hi,

Welcome to icliniq.com.

I understand your concern.

Thanks for sharing your story and the pictures (attachments removed to protect the patient's identity). They helped me understand the rash more. I know you’re worried about your baby, and I’m glad you reached out.

Based on your history and the images you have shared, it seems you have chronic recurrent tinea cruris with extension to tinea corporis involving the vulvar skin (external skin, not vaginal mucosa) and buttocks.

The persistence of fungus is due to hormonal changes, sweating, occlusion, weight changes, and altered immunity, and recurrence after pregnancy is very common. Short-term symptomatic relief may be achieved with long-term application of topical creams, especially combination creams, but the fungus is generally not cured, and relapses are common.

Regarding the use of Itraconazole during breastfeeding, Itraconazole does pass into breast milk in very small amounts, so it is generally not considered safe during breastfeeding or pregnancy.

Among antifungals, the only one deemed safe during breastfeeding is Terbinafine, which works slowly but effectively. While you are lactating, I suggest starting with Terbinafine 250 mg. Take it twice a day for at least four to six weeks.

This medication, along with a topical antifungal, will also help to control your infection. I know how upsetting this can be, but the safety of your baby is also very important.

Change to Sertaconazole cream topical application. Apply twice daily to the affected area. You can take Loratadine 10 mg at night time for itching. This is safe in lactation.

Keep the area dry and wear loose cotton underwear, change out of sweaty clothes quickly, avoid tight leggings, and do not share towels.

It is also important for your partner to be examined or treated if they have any symptoms, as reinfection is common.

With this regimen, you should see improvement and possibly clear the infection within four to six weeks. Once the infection is completely cleared, I suggest continuing the topical medication for an additional two weeks to eliminate any remaining fungal remnants in the skin; otherwise, there is a chance of relapse.

I hope this information helps with your situation.

Thank you.

Hi,

Welcome back to icliniq.com.

I understand your concern.

Fluconazole is the most commonly used and studied oral antifungal in breastfeeding women. It is also considered the safest.

However, it is important to note that fluconazole is generally ineffective for dermatophyte infections (tinea cruris, tinea corporis). So that makes it a less good choice for your particular case.

Itraconazole and oral Terbinafine are excreted in very small amounts in breast milk. Studies have suggested that low-dose Itraconazole for a short duration during lactation can be used.

However, it is important to understand that underdosing Itraconazole is not likely to control a chronic or recurrent tinea infection effectively.

Given your current situation, the safest route would be to avoid oral antifungals during lactation and use aggressive and appropriate topical therapy.

Once done with nursing, you can start a full and effective course of Itraconazole orally, which would be a much better chance of completely getting rid of the infection instead of temporary relief.

Combination topical therapy has been shown to provide better control within this time period. Use agents with different mechanisms of action to improve the clearance of fungi.

The practical and effective regimen is to use a fungicidal agent in the morning, such as topical Terbinafine, and a fungistatic agent at night, such as topical Clotrimazole, Ketoconazole, or Sertaconazole.

This approach helps reduce the fungus, stop it from spreading, and control symptoms until you can safely start oral medicine.

If you have any more questions, just ask.

Thank you very much.