To Star and all else, When I wrote that I would provide references, I was not referring to official published research per se, but rather to the Red Book, and also to the MDs on our list who work with diflucan and have experience in the issue of necessary therapeutic dosages for nursing moms. Shirley Gross, Anne Eglash and Anne Norton-Krawciw have all posted their protocols and experience, and I would cite their experience and ask our MD to consider contacting them if it was still an issue. I did not mean to be misleading regarding published research, nor do I want the physicians in my community to think that I've made up these recommendations on my own! But, since you've brought up the point, I feel compelled to investigate this all a little further. To that end, I called Roerig Pfizer and talked with two of their reps about all of this. I would like to report my findings to lactnetters, and enlist your help to break this issue free for all of us. First of all, though I was inquiring about the usage of diflucan for ductal yeast, it was quickly stated to me that diflucan is "contraindicated" for breastfeeding mothers, and they cited the now famous case-of-one test on a 29yr old mom who took the 150mg one shot therapy for vaginitis. I responded to the rep that diflucan is now approved for pediatric usage, but she was still compelled to repeat the official company line, which I then wanted to challenge. So, I was sent up the ladder to a pharmacist for the company, and after wading through the legal issues, I was able to ascertain that she realized that their statement was based on lack of FDA review for this usage, NOT on a history of problems. She quickly agreed with me that the way they now phrase their statement on the phone implies a history of problems _"contraindicated"_ and I suggested that they reword their statement to something more along the lines of "diflucan has not been reviewed for this particular application by the FDA, and therefore is not officially sanctioned", etc. etc. The pharmacist mentioned that if we had published case reports, it would help immeasurably, and I pointed out to her that if they continue to respond to inquiries with "contraindicated", that it is unlikely that there will be many case reports to study, having scared all the docs off! Our discussion went on to affirm the excellent safety profile of diflucan in all populations, and the relatively small risks, especially when the alternative is artificial baby milk for baby. In pursuit of the question of proper treatment of ductal yeast, disregarding the issues of safety during breastfeeding, I questioned the pharmacist on whether she would categorize ductal yeast as "systemic". After a slight pause for thought, she said yes, she would consider this a systemic problem. I told her that my point in asking this question was to ascertain if there was sufficient reason to warrant the application of official recommendations of diflucan for systemic treatment-- 7-10 days, and she felt that there is sufficient reason. In fact, she reiterated that it should probably be treated with the same protocol as is applied for oral candida-- 7-10 days. Thus, in terms of validating the need for long term vs one shot therapy of ductal yeast, the pharmacist for the company was in agreement with "our" analysis of the situation, that ductal yeast would best be treated with longer term dosing. My final point with her was to encourage the company to do clinical tests that would officially validate the usage of diflucan in breastfeeding mothers and establish dosing protocol. I pointed out to her that we really don't have tx alternatives other than Nizoral, which is not as "safe"; that with increased prophylactic antibiotic usage the ductal yeast rates are rising; and that the only alternative in cases that do not spontaneously resolve is to recommend weaning, which, considering the true risks involved, is rather ridiculous [she agreed]. I also pointed out that her company wants to make money, and studying this drug for breastfeeding mothers would most likely result in greater sales for the company--- the appeal of the almighty dollar, the basis of American capitalism! She suggested that I -- or we--- contact the PhD who is in charge of clinical trials to make our request known. Perhaps if we all voice the request that this company pursue approval of diflucan for use in breastfeeding mothers, the company will consider taking this on officially. Here is the person whom we need to address our concerns: Helene Panzer, PhD Pfizer Inc 235 E. 42nd St, 14th floor New York, New York 10017 I would especially love to see the MDs on our list make this suggestion, and also share their experience with Ms. Panzer. I don't see the yeast issue abating anytime soon given the current obstetrical climate; let's be proactive! And as of right now, though we have our own good sources, I would hate to have an MD contact Roerig to try to validate what we are saying, as Roerig Pfizer's current approach is CYA rather than bfg friendly. It was also suggested to me that if there are published case studies using diflucan, that we need to bring these to the company's attention (probably to Ms. Panzer) so that they can be incorporated into the data base and made available to the reps who say those lovely things like "contraindicated" and "no other information". -Lisa Marasco, BA, IBCLC Santa Maria, CA