Clotrimazole for thrush: Does it need to be removed?

I am going to start my first year of pharmacy school in the fall and am presently working with a pediatric pharmacist for the summer. She asked me to research a question posed to her by a physician. He wanted to know if there is any reason why a breastfeeding mother suffering from candidiasis has to wipe the clotrimazole cream off her breasts before breastfeeding her infant. (i.e. Is there anything intrinsically toxic to the infant either in the clotrimazole or the base of the cream (preservatives, etc.)?

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Debbi Donovan

Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more

This is an excellent question. Clotrimazole is a broad-spectrum antifungal often used in the treatment of nipple thrush.

"Antifungals such as nystatin and miconazole would not be a problem for the baby to ingest in small quantities. The problem is the base with which the antifungal is mixed. They come in cream and ointment bases. I would guess the base might be similar to a hand lotion. Is this toxic in small amounts?

Most of the medication rubs off on the clothing. However, if a woman is wearing breast shells, then she still would have a considerable amount left. I suggest rinsing the nipples before breastfeeding. I do not know of any information in the breastfeeding literature that explains what base is used for the various antifungal preparations."

Personal conversation with Kay Hoover, MEd, IBCLC, co-author of Candidiasis and Breastfeeding, and well-known speaker on Thrush and Breastfeeding. Kay is in Private Practice in Delaware County, Pennsylvania.

Since the base used for antifungal preparations may be of some question, I would also recommend that a mother using this type of medication on her nipples, rinse nipples gently prior to nursing her baby. The medication can then be reapplied following a feed. Best wishes!

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