Safe use of antimalarial agents: pregnancy & breastfeeding
Pregnancy
Limited human data, mostly on use in 2nd and 3rd trimester.
Should be used only when the benefit outweighs the unknown risk to the fetus.
Breastfeeding
No human data.
The quantity of antimalarial drugs transferred in breast milk is insufficient to provide adequate protection against malaria for the infant.
Pregnancy
- Limited human data, mostly on use in 2nd and 3rd trimester.
May be used to treat uncomplicated chloroquine-resistant P. falciparum infection if other options are not available or not suitable AND the benefit of its use outweighs the unknown risk to the fetus.
Plasma concentrations of atovaquone and proguanil were found in one study to be lower in pregnant women due to an increase in clearance and volume of distribution. It should be noted that all women in this study were cured of their initial infection in 1-3 days. Thus, the clinical significance of those pharmacokinetic changes is unclear.
Breastfeeding
No human data.
Not expected to cause adverse effects in breastfed infants weighing > 5 kg.
The quantity of antimalarial drugs transferred in breast milk is insufficient to provide adequate protection against malaria for the infant.
Pregnancy
Not expected to increase risk of major congenital malformations.
Breastfeeding
Not expected to cause adverse effects in breastfed infants.
The quantity of antimalarial drugs transferred in breast milk is insufficient to provide adequate protection against malaria for the infant.
Pregnancy
Not expected to increase risk of major congenital malformations above the baseline risk in general population.
Recommended for treatment of uncomplicated chloroquine-resistant P. falciparum infection.
Breastfeeding
An alternate drug may be preferred in a nursing mother; however, if clindamycin is required by a nursing mother, it is not a reason to discontinue breastfeeding.
Monitor nursing infant for possible diarrhea, oral thrush, and for blood in the stool suggestive of antibiotic-associated colitis (rare).
The quantity of antimalarial drugs transferred in breast milk is insufficient to provide adequate protection against malaria for the infant.
Pregnancy
Should be avoided after 4-5 months of gestation, due to reports of possible discoloration of the deciduous teeth.
Breastfeeding
Low levels in breast milk and low oral bioavailability in the infant.
Short-term use is not expected to cause adverse effects in breastfed infants.
Prolonged or repeated treatment courses during nursing should be avoided (theoretical precaution).
Monitor nursing infant for GI symptoms.
The quantity of antimalarial drugs transferred in breast milk is insufficient to provide adequate protection against malaria for the infant.
Pregnancy
Should be used only when the benefit of its use outweighs the unknown risk to the fetus.
Prophylactic administration of this drug should be withheld until after delivery.
There is a theoretical risk of hemolytic anemia in a G6PD-deficient fetus.
Breastfeeding
Not expected to cause adverse effects when breastfeeding mothers and children with normal G6PD levels.
The quantity of antimalarial drugs transferred in breast milk is insufficient to provide adequate protection against malaria for the infant.
Pregnancy
Limited human data, mostly on use in 2nd and 3rd trimester.
May be used to treat uncomplicated chloroquine-resistant P. falciparum infection if other options are not available or not suitable AND the benefit of its use outweighs the unknown risk to the fetus.
Plasma concentrations of atovaquone and proguanil were found in one study to be lower in pregnant women due to an increase in clearance and volume of distribution. It should be noted that all women in this study were cured of their initial infection in 1-3 days. Thus, the clinical significance of those pharmacokinetic changes is unclear.
Breastfeeding
No human data.
Not expected to cause adverse effects in breastfed infants weighing > 5 kg.
The quantity of antimalarial drugs transferred in breast milk is insufficient to provide adequate protection against malaria for the infant.
Pregnancy
Not expected to increase risk of major congenital malformations when used in therapeutic doses.
Reccommended for treatment of uncomplicated chloroquine-resistant infection caused by P. falciparum and P. vivax.
Breastfeeding
Not expected to cause adverse effects when breastfeeding mothers and children with normal G6PD levels.
The quantity of antimalarial drugs transferred in breast milk is insufficient to provide adequate protection against malaria for the infant.
