Gentian Violet use while Breastfeeding

Drugs containing Gentian Violet: Triple Dye, Kerr Triple Dye

Gentian Violet Levels and Effects while Breastfeeding

Summary of Use during Lactation

Gentian violet (crystal violet) was used in the past to treat oral and nipple thrush during breastfeeding. Gentian violet is potentially toxic to the mucous membranes, causing ulceration,[1][2][3][4] and potentially tattooing the skin. It can also interact with DNA[5], is carcinogenic and mutagenic in rodents, and occasionally causes allergic sensitization, with cross reactions to other triphenylmethane dyes.[6] Its use has been severely curtailed by authorities in England and Australia.[7][8] It is also very messy, staining skin and clothing. A 2001 survey of the members of the Academy of Breastfeeding Medicine found that gentian violet is rarely (1 to 2% of respondents) used by breastfeeding experts for initial treatment of oral thrush and is very infrequently (3 to 4% of respondents) used for recurrent or persistent thrush.[9] The use of gentian violet should be avoided topically on the nipples or in the infant's mouth; safer alternatives for treating thrush are available.[10]

Drug Levels

Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Gentian violet has caused oral ulceration in breastfed infants treated with 1% or 2% solution applied to the mouth and tongue for thrush.[1][2][3]

A 2-week-old exclusively breastfed infant was treated for oral thrush with aqueous 1% gentian violet solution twice daily for 1 day. The parents discontinued it because they thought it was causing airway discomfort. After 2 days, it was restarted at 4 times a day. Cough and difficulty feeding developed after 1 day and the infant was then admitted to the hospital, ultimately requiring intubation.[4]

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

Alternate Drugs to Consider

Clotrimazole, Fluconazole, Miconazole, Nystatin

References

1. Bjornberg A, Mobacken H. Necrotic skin reactions caused by 1 per cent gentian violet and brilliant green. Acta Derm Venereol. 1972;52:55-60. PMID: 4111108

2. Utter AR. Gentian violet treatment for thrush: can its use cause breastfeeding problems. J Hum Lact. 1990;6:178-80. Letter. PMID: 2271112

3. Utter AR. Gentian violet and thrush. J Hum Lact. 1992;8:6. Letter. PMID: 1558661

4. Baca D, Drexler C, Cullen E. Obstructive laryngotracheitis secondary to gentian violet exposure. Clin Pediatr (Phila). 2001;40:233-5. PMID: 11336425

5. Rosenkranz HS, Carr HS. Possible hazard in use of gentian violet. Br Med J. 1971;3:702-3. Letter. PMID: 5569557

6. Bielicky T, Novak M. Contact-group sensitization to triphenylmethane dyes. Gentian violet, brilliant green, and malachite green. Arch Dermatol. 1969;100:540-3. PMID: 5350405

7. Phillips V. Is gentian violet safe? J Hum Lact. 1993;9:7-8. PMID: 8489730

8. Hoppe JE. Treatment of oropharyngeal candidiasis and candidal diaper dermatitis in neonates and infants: review and reappraisal. Pediatr Infect Dis J. 1997;16:885-94. PMID: 9306485

9. Brent NB. Thrush in the breastfeeding dyad: results of a survey on diagnosis and treatment. Clin Pediatr (Phila). 2001;40:503-6. PMID: 11583049

10. Stoukides C. Topical medications and breastfeeding. J Hum Lact. 1993;9:185-6. PMID: 8260040

Gentian Violet Identification

Substance Name

Gentian Violet

CAS Registry Number

548-62-9

Drug Class

Anti-Infective Agents, Local

Administrative Information

LactMed Record Number

951

Last Revision Date

20130907

Disclaimer

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