Re: Metronidazole and Breastfeeding

[Guest guest]

Larissa, I would think your gynecologist is most up on the

information. The controversy sounds like it's over how much topical

metronidazole is absorbed systemically.

Here's what in the package insert for Noritate (one of the topical

metronidazole):

Nursing Mothers: After oral administration, metronidazole is

secreted in breast milk in concentrations similar to those found in

the plasma. Even though blood levels taken after topical

metronidazole application are significantly lower than those achieved

after oral metronidazole, a decision should be made whether to

discontinue nursing or to discontinue the drug, taking into account

the importance of the drug to the mother and the risk to the infant.

Also from the package insert, it appears that topical metronidazole

is absorbed into the bloodstream at about 1% of a typical oral dose,

although half of the volunteers had no detectable levels. Also, a

gram dose is a good-sized portion:

Pharmacokinetics: When one gram dose of NORITATE cream, 1%, was

applied in a single application to the face of 16 healthy volunteers,

low concentrations of metronidazole were detected in the plasma of 7

of the volunteers. The mean ± SD C max of metronidazole was 27.6 ±

7.3 ng/mL, which is about 1% of the value reported for a single 250

mg oral dose of metronidazole. The time to maximum plasma

concentration (T max ) in the volunteers with detectable

metronidazole was 8-12 hours after topical application.

So, a number of things to factor in. Your dermatologist and your

obstetrician would know best, although it's worth asking your baby's

pediatrician why he doesn't recommend it, and asking your dermatology

why she does, to give you a sense if their reasons for you make

sense.

Let us know what you decide to do. Good luck!

Marjorie

Marjorie Lazoff, MD

> Hi,

> I was just diagnosed with cea and encouraged to start treatment

> right away. However, I am currently breastfeeding so my options are

> limited. I was prescribed Metronidazole, but my baby's pediatrician

> think is not compatible with breastfeeding.My dermatologist thinks

that

> is perfectly fine. Has anyone had this same situation? I would

> appreciate any advise in this matter.

> Thanks,

> larissa