Acne Medications and Breastfeeding

July 28, 2011. Posted in: Medications & Vaccines

Info on selected acne meds

The information summarized below is only a general overview. For detailed information on the specific drugs, please review the references listed below with your health care provider.

Over-the-counter topical acne medicines containing benzoyl peroxide or salicyclic acid are considered compatible with breastfeeding. Per Thomas Hale, PhD (author of Medications and Mothers’ Milk), “The transcutaneous absorption of both of these drugs is minimal to nil. Peroxides, even if absorbed, would be instantly metabolized in the body and would not be able to reach the milk compartment.”

Proactiv is considered compatible with breastfeeding and is a more preferable acne treatment for nursing moms than oral antibiotics. The active ingredient in the Proactiv products is benzoyl peroxide (see the above paragraph).

Most oral antibiotics are compatible with breastfeeding, but they can put you and your baby at greater risk for thrush and should be taken only when absolutely necessary. Topical antibiotics pose less of a risk.

A common antibiotic used for acne treatment (both topical and oral) is erythromycin, which is approved by the American Academy of Pediatrics for use in breastfeeding mothers and is classified in Lactation Risk Category L1 (safest).

Another common antibiotic used for acne treatment is MetroGel (metronidazole). Per Hale, “the topical application of metronidazole gel provides only exceedingly low plasma levels in the mother and minimal to no levels in milk.”

Topical use of Retin-A (tretinoin) is generally considered compatible with breastfeeding. Per Thomas Hale, PhD (Medications and Mothers’ Milk), “absorption of tretinoin [Retin-A] via topical sources is reported to be minimal, and breastmilk concentrations would likely be minimal to none. However, if it is used orally, transfer into milk is likely and should be used with great caution in a breastfeeding mother.” This med is classified in Lactation Risk Category L3 (moderately safe).

Per Hale, Differin Gel (Adapalene 0.1%) is similar to Retin-A (retinoic acid or tretinoin). “Adapalene is virtually unabsorbed when applied topically to the skin. Plasma levels are almost undetectable, so milk levels would be infinitesimally low and probably undetectable.”

Azelex (azelaic acid) is another topical acne treatment that is not likely to enter milk or cause problems in a breastfed baby. Per Hale, it is minimally absorbed and rapidly metabolized. Small amounts of azelaic acid are normally found in whole grains, animal products and in human milk.

Accutane (isotretinoin) should not be used by nursing moms. Hale rates it in Lactation Risk Category L5 (contraindicated), and the manufacturer strongly recommends against using this drug in a breastfeeding mother.

Acne Medicines
Name of medication
AAP approved?*
Pregnancy Risk Category**
Adapalene (Differin)
not reviewed
C
L3
Azelaic acid (Azelex)
not reviewed
B
L3
Clindamycin (Cleocin)
yes
B
L3
Erythromycin
yes
B
L1
Isotretinoin (Accutane)
not reviewed
X
L5
Metronidazole (MetroGel)
not reviewed
B
L3
Tretinoin (Retin-A, Renova)
not reviewed
B (topical Retin-A)
C (topical Renova)
D (oral)
L3

*  Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.
** Per Medications’ and Mothers’ Milk by Thomas Hale, PhD (2002 edition)

 Lactation Risk Categories   Pregnancy Risk Categories 
  • L1 (safest)
  • L2 (safer)
  • L3 (moderately safe)
  • L4 (possibly hazardous)
  • L5 (contraindicated)
  • A (controlled studies show no risk)
  • B (no evidence of risk in humans)
  • C (risk cannot be ruled out)
  • D (positive evidence of risk)
  • X (contraindicated in pregnancy)
NR: Not Reviewed. This drug has not yet been reviewed by Hale.

 

References

Table 6: Maternal Medication Usually Compatible With Breast-Feeding, from the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.

Hale, Thomas. Medications and Mothers’ Milk, 10th Edition. Pharmasoft Medical Publishing, 2002. Dr. Hale’s website is located at http://neonatal.ttuhsc.edu/lact/index.html.

Links for additional information

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