Cefpodoxime use while Breastfeeding
Drugs containing Cefpodoxime: Vantin
Cefpodoxime Levels and Effects while Breastfeeding
Summary of Use during Lactation
Limited information indicates that cefpodoxime produces low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Cefpodoxime is acceptable to use during breastfeeding.
Maternal Levels. According to the manufacturer, levels of cefpodoxime in the milk of 3 nursing mothers were 0%, 2% and 6% of concomitant maternal serum levels at 4 hours following a 200 mg oral dose of cefpodoxime proxetil. At 6 hours after the dose, levels were 0%, 9% and 16% of concomitant maternal serum levels. No study details or measured milk levels were provided. After a 200 mg oral dose, the average peak serum level is 2.3 mg/L. Using this serum level and the maximum reported milk to plasma ratio of 0.16 above, a fully breastfed infant would receive a maximum daily dose of about 0.055 mg/kg daily after a maternal dose of 200 mg, compared to the recommend treatment dosage of 10 mg/kg daily for infants of 2 months or older.
Infant Levels. Relevant published information was not found as of the revision date.
Effects in Breastfed Infants
Relevant published information was not found as of the revision date.
Effects on Lactation and Breastmilk
Hyperprolactinemia and bilateral galactorrhea occurred in a nonpregnant, 40-year-old woman taking cefpodoxime 200 mg twice daily for 2 days. Seven days after stopping the drug, galactorrhea ceased and the serum prolactin dropped markedly into the normal range. One month later it had dropped further. Because no other cause could be found, the authors determined that the galactorrhea and hyperprolactinemia were probably caused by cefpodoxime.
The prolactin level in a mother with established lactation may not affect her ability to breastfeed.
Alternate Drugs to Consider
1. Khurana V, Gambhir IS. Cefpodoxime-induced hyperprolactinemic galactorrhea. Ann Intern Med. 2010;152:136. Letter. PMID: 20083845
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