Safe use of antifungal agents: pregnancy & breastfeeding
Pregnancy
Not expected to increase risk of major congenital malformations.
Should be used only when benefit outweighs unknown risk to the fetus.
Breastfeeding
No human data.
Low oral bioavailability.
Not expected to cause adverse effects in breastfed infants.
Pregnancy
No human data.
Embryotoxic in animal studies.
Should be avoided in 1st trimester, whenever possible.
Breastfeeding
No human data.
Low oral bioavailability.
Not expected to cause adverse effects in breastfed infants.
Monitor breastfed infant for symptoms of histamine release.
Monitor breastfed infant for GI symptoms.
Pregnancy
May increase the risk of spontaneous abortion when used in low doses (150 mg) for vaginal candidiasis; suggest use of topical miconazole as first-line therapy, unless contraindicated.
There are case reports of congenital anomalies with prolonged use in doses > 400 mg/day during the 1st trimester. (Causation has not been proven).
Breastfeeding
Amounts found in breast milk are lower than the neonatal fluconazole dose.
Considered safe during breastfeeding
Pregnancy
Limited human data.
Not expected to increase risk of major congenital malformations.
Breastfeeding
No human data.
Use of an alternate agent with a known safety profile would be preferred
Pregnancy
May cause fetal harm when administered to pregnant woman.
Should not be used during pregnancy unless the potential benefit to patient outweighs the risk to fetus.
Breastfeeding
Should not breastfeed while taking isavuconazole.
Pregnancy
Limited human data.
Can be considered when other agents have failed and the benefit outweighs the unknown risk to the fetus.
Breastfeeding
No human data.
Pregnancy
No human data.
Should be used only when benefit outweighs unknown risk to the fetus.
Breastfeeding
No human data.
Pregnancy
No human data.
Animal studies have suggested voriconazole is teratogenic and embryotoxic.
Should be avoided during pregnancy at least for the 1st trimester unless other treatments have failed and the benefit outweighs the unknown risk to the fetus.
Breastfeeding
No human data.
