Terbinifine

[barbibclc]

I am working with a 3rd time breastfeeding mum(currently feeding a 5 week old baby) who has been told by her dermatologist to "pump and dump" her milk for 6 weeks as she has to take Terbinifine orally for tinea capitis that has been present for about 1-2 years. She is African and previously had braids but has shaved her head hoping that this will improve her situation. She is currently wearing a wig when out. She does not want to stop breastfeeding.
Questions..
Would a topical antifungal such as Lamisil in this situation allow breastfeeding to continue?
If she takes the Terbinifine orally, how much is transferred into milk?
Are there other antifungals that are compatible with breastfeeding that could be used in this situation?

Regards
Barbara
RN IBCLC

[admin]

Barb:

Terbinafine transfer into milk is really quite low. See below, 0.13% to 0.03% of the total maternal dose, and there are recommended pediatric doses for children 10-20 Kg (62 mg daily for 6 weeks). So I think this product is probably safe for this mother to use and continue to breastfeed. At these doses, the recommended dosing period ranges from 2-6 weeks.

I do have one other suggestion. One of the therapies they use for severe athlete's foot is: one tablet daily for 7 days, every 3 months. This way they avoid the liver toxicity associated with the prolonged daily use of terbinafine. I'm wondering if the physician might be agreeable to using something like this for 7 days followed by another 7 days in a month or so. Just a suggestion.


Tom Hale R.Ph., Ph.d.
InfantRisk Center



------------------------From Medications and Mothers Milk 2016 ---------------------------

Systemic absorption following topical therapy is minimal.[1] Following an oral dose of 500 mg in two volunteers, the total dose of terbinafine secreted in breastmilk during the 72 hour post-dosing period was 0.65 mg in one mother and 0.15 mg in another.[2] The total excretion of terbinafine in breastmilk ranged from 0.13% to 0.03% of the total maternal dose respectively. Topical absorption through the skin is minimal.[3]