To : Lyla Re : Clotrimazole Of the azole antifungal family, some are known to be more hepatotoxic than others. In pediatrics numerous studies have shown that the risk of elevated liver enzymes is lowest with fluconazole, and slightly higher with clotrimazole. While the risk is relatively low, it is nevertheless worth mentioning. I have for some time advocated the use of oral fluconazole as the better choice for treating systemic and breast fungal infections, due to its low milk levels and its rather limited hepatotoxicity, and its FDA clearance in infants 6 months and older. Topically I generally prefer miconazole, simply because it is relatively nontoxic to the liver, cleared for pediatric use, and it is poorly bioavailable orally. For this reason, any left on the nipple and ingested by the infant would be only minimally absorbed. However, if the mom has clotrimazole available or the physician prefers it, then I would not be overly concerned about using it, if the mom uses it sparingly on the nipple. Basically, if you can see it on the nipple, you've used too much. I would not necessarily advocate the chronic use of any of these azole members(month after month). To : Elaine Re : Prozac As for the use of Prozac in this patient, the fact that this infant is already 2 months old and has had no discernable side effects, it is more likely that the risk of Prozac toxicity will diminish as the infant ages. I am most concerned with Prozac's use in the first month or two, particularly in those women who have used it during pregnancy. As for converting her to Zoloft, that may or may not work. Please remember, that the SSRI family is not always interchangeable. While one patient may do fine on Prozac, they may do poorly on Zoloft. No one knows why some work and some don't...its just a fact of life in depression that you may have to change from one drug to another until you find one that is perfect for you. In this case, I would relax and just have the mom observe the infant for tremor, colic, insomnia, and excitement. I doubt they will occur at this date postpartum. Regards Tom Hale, Ph.D. *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html