Voriconazole

[shamsieh2]

I am inquiring about any data you might have on the use of Voriconzole while breastfeeding. This medication is starting to be used more frequently in our region for the treatment of coccidiodomycosis, at a dose of 200 mg q daily, often for prolonged periods of time. All I am able to find is that it is more highly protein-bound than Fluconazole with a similar molecular weight. Some of our local lactation and infectious disease specialists seem to have reservations about its use while breastfeeding (related to upgrading of high dose triazoles to category D in pregnancy?)

Is it safe to assume that its use would be comparable to that of Fluconazole during lactation?

Thank you in advance!

[admin]

Shamsieh2:

Voriconazole is just another triazole antifungal, almost identical in structure to Fluconazole. As the dose is similar to fluconazole (100-200 mg daily), I would assume milk levels will be in about the same range. Thus far, I've only had one case report of elevated liver enzymes in a breastfeeding infant but this mother was consuming 400 mg/day fluconazole.

If kept to the 100-200 mg range, I would assume the risk to the infant is moderately low. But until we know more, I'd recommend liver enzymes on the infant at 1 month, 3 months and 6 months.

Tom Hale Ph.D.