IF mom's deep breast pain continues after GV, (the deep pains often
resolve during GV use...presumably referred nipple pain) I have been
using 400mg X1, then 200mg QD X2weeks.  I would say 2 weeks is enough
for about 25%, if you want them to be completely symptom-free for at
least a week.  Most need another 2 weeks, and the dose at that point is
reaaly subjective...if they still have deep pain at all, I do another 2
weeks of 200mg/d.  If they are completely clear of symptoms for < 1
week, I I will often go to 100 mg/d for two weeks.  If mom takes close
to 4 weeks to clear on 200 mg/d, I will often do a taper, such as 100
mg/d x2 weeks, then every other day for another 2 weeks.  The theory
being that since Diflucan does  not kill yeast, just keeps it from
dividing, it can help susceptible women to stay on top of it if you
slowly take the drug away, rather than suddenly.

Having said that, I am not completely comfortable with using Diflucan
for this purpose, even though I do all the time.  I wish we had some
objective evidence about what yeast actually does within the breast, if
anything.

I am anxious to hear what others are seeing/doing...

Kathy Leeper, MD, IBCLC
Lincoln, NE

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