Fluconazole for thrush - any experience??

[foodaholic]

Would really appreciate some guidance on the use of fluconazole for thrush when breastfeeding. I have a 4 week old DS and seem to have developed a pretty severe case of thrush that has spread into my milk ducts - have serious internal breast pain that gravitates into my back. I'm using clotrimazole topical cream and nystatin for my DS but I know that the only way to fully get rid of this is with Fluconazole although this isn't licenced for b/f women. I have the B/f network leaflet which says that there is little risk in continuing to b/f while taking this drug as it's given to babies in higher doses than the amount that would get to the baby via breast milk. However, I still feel pretty uneasy about using it given that my DS is so young and there have been no real studies carried out. I really really don't want to quit b/f and the thought of this makes me cry but don't want to put DS at any risk. Still haven't been to my GP so may struggle to get prescription for fluconazole anyway. Has anyone used this successfully or anyone chose not to bother? If so, what did you do? Would it be possible to put him on formula for 10 days while I take the drug and then try to get him back on the breast whilst I continue to express?? I've considered just continuing with the pain and managing it with painkillers but concerned that it'll just get worse or he'll end up with a severe case of oral thrush and not want to nurse at all. Feeling pretty stressed about whole situation so any help at all would be appreciated. Thanks

Many breastfeeding women have used Fluconazole. Wendy, who does the BfN leaflet, really does know what she is doing and is a specialist in drugs in breastmilk.

The reasons is isn't licensed is because they can't run trials on breastfeeding women it would be considered unethical. However, many women have used it and the amount of fluconazole that would actually reach your baby is very small.

If you have any concerns, you could phone the BfN Drugline and talk it through with someone. (Number is on the BfN website.)

Regarding the formula, what if your baby is dairy intolerant?

Formula is not without its risks - I personally would just take the fluconazole (and did, when I had thrush).

Thanks for your help. I'm maybe just being paranoid. I call the Bfn line to ease my mind. Out of interest, what are the risks with formula?

I've taken a fairly high dose of fluconazole while bfing my baby - my GP had bf three children herself so knew it was safe to prescribe.

I also used fluconazole when my DS was 4-5 weeks old as the pain was so severe and as far as I know it's the only way to shift the thrush once it hits your milk ducts. There are various alternative remedies (for instance, I'm still eating probiotic yogurts every day and pau d'arco capsules as I've been on antibiotics since and am so paranoid about getting thrush again) but flucozanole is what works for milk ducts.

Check out this NHS website for some more info/reassurance - as it says, the amount of flucozanole that reaches your baby is far smaller than the amount your baby could be prescribed directly. This is what put my mind at ease.

Also, I wasn't actually prescribed it = my locum GP wouldn't as it's not licensed , makes me wish my GP was like Belgo's! - so I just bought it over the counter from various chemists (both highstreet and online) - you can only buy 2/3 doses at a time, which is why I had to buy from various places to get enough for the 10 day treatment.

From how I understand it, there aren't risks with formula feeding as such (unless you count the risk associated with not preparing it properly) but rather you would lose the benefits of exclusive breast feeding.

Good luck with treatment - I found the flucozanole worked quickly to reduce the pain.

foodaholic - some links on side-effects/risks of introducing formula:
drjaygordon.com/pediatricks/startingout/supplement.html
www.whale.to/b/thomas.html

Cant comment on the fluconazole but wanted to say that we found Nystatin to be absolutely rubbish for our DD. We did one course of it which didnt seem to make much of an impact on the thrush at all. Switched to Daktarin oral gel when the nystatin ran out and it has made an amazing difference in just 2 days. DD is eating happily again.

you can get it over the counter at the chemist and just rub it on LO's affected area twice a day.

Defo. agree with TheSugarPlumFairy - we had better success with the Daktarin too.

Thanks for all the advice. I've arranged to see my doctor later in the week about the fluconazole. I'll definitely switch to Daktarin for my DS too

Poor you, foodaholic- had severe thrush a few months ago, when baby was 3 weeks old, so understand and sympathise. We tried the treatments you are having, then switched to Daktarin oral gel and canesten cream for me, plus oral fluconazole for 14 days (had not cleared fully after 10). Am delighted to report it worked well and we are still fully breastfeeding at 20 weeks. If bfding is too painful now (it certainly was for me, even on 4g paracetamol per day), why not express and feed your baby EBM? It is not easy, but giving the nipples a few days' rest did wonders for me... Good luck!