Greetings Lactnetters,

I should probably reintroduce myself as I have been away for a while.  I am
a family physician with a special interest in breastfeeding.  I direct a
breastfeeding clinic and teach the medical students at the local medical
school.  I also tend to hang out at breastfeeding conferences!!

I recently found an interesting notice in the Canadian Adverse Drug Reaction
Newsletter about fluconazole.  It was reported in the Canadian Medical
Association Journal's January edition. (1) Here are some quotes:

"Fluconazole is a systemic antifungal agent and is used for the treatment or
oropharyngeal and esophageal candidiasis, other serious candidal infections
and cryptococcal meningitis.

There are now three reports of women who were receiving high doses of
fluconazole (400 - 800 mg/d) for the treatment of coccidiodal meningitis (an
unapproved indication in Canada) for at least the first 4 months of their
pregnancies.   The similarities of the anomalies in all three cases to those
observed in mouse and rat embryos exposed to fluconazole suggest that the
drug may cause teratogenic effects in humans, including craniofacial,
skeletal and cardiac anomalies.

There is evidence to indicate that the teratogenic effects may be dose
dependent.  A retrospective review of adverse events following the
introduction of fluconazole for vaginal candidiasis in the United Kindgom
did not reveal any unusual pattern of fetal abnormalities among the women
who received a single dose of 150 mg during pregnancy.  This was however
based on a small number of patients.

Their summary:  fluconazole is not recommended in pregnant women unless the
potential benefit outweighs the risk to the mother and fetus.  In addition,
women of childbearing age who are taking fluconazole should be counselled
regarding the use of adequate contraception because of the potential for
birth defects."

Might be good to remember this as we treat patients with nipple and breast
thrush.

1.  Wray CM.  Congenital anomalies and fluconazole.   Canadian Adverse Drug
Reaction Newsletter 1997;7(1)  published in CMAJ Jan 1, 1997;156(1)
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M. Shirley Gross M.D.,C.M., C.C.F.P.
Director, Edmonton Breastfeeding Clinic
Assistant Clinical Professor, University of Alberta
Dept. of Obstetrics and Gynaecology and Dept. of Family Practice
E mail  < [log in to unmask] >
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