Jess asked
Can you breastfeed while on Levaquin (levofloxacin)?
Answer
Levaquin (levofloxacin) is excreted in small quantities into the breast milk, and therefore caution is advised before taking the antibiotic and breastfeeding. The prescribing information for Levaquin states the following:
"Based on data on other fluoroquinolones and very limited data on LEVAQUIN®, it can be presumed that levofloxacin will be excreted in human milk. Because of the potential for serious adverse reactions from LEVAQUIN® in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother."
Concern With Levaquin While Breastfeeding
Although we know that Levaquin is excreted into the breast milk, the effects on a nursing infant are not well know. Levaquin is part of the fluoroquinolone family of antibiotics, which have been associated with arthropathy (i.e. joint diseases) in young animals of several species. Studies in humans have also reported similar risks in the use of fluoroquinolones in children.
In fact, Levaquin isn't used in children or adolescents unless absolutely necessary due to the rare, but serious risk of joint disorders. The American Academy of Pediatrics Committee on Infectious Diseases recommends reserving the use of systemic fluoroquinolones, like Levaquin, for only serious infections, such as those caused by multidrug-resistant pathogens for which there are no other safe and effective alternatives.
How High Is The Risk Of Breastfeeding While On Levaquin?
While there does appear to be some risk taking Levaquin while breastfeeding, it isn't thought to be very high. One case report showed that peak concentration of Levaquin in breast milk in a woman receiving 500 mg/day was 8.2 mcg/mL at 5 hours after a dose. The estimated maximum dose that an exclusively breast-fed infant would receive is around 1.23 mg/day (based on average infant breast milk consumption). This small dose is far less than what has been studied in children.
Another study showed the Levaquin levels in the breast milk are highest 2 hours after maternal dosing and fall rapidly thereafter:
- Breast milk concentration of 2.4 mg/L of Levaquin 2 hours after the dosing.
- Breast milk concentration of 1.9 mg/L of Levaquin 4 hours after the dosing.
- Breast milk concentration of 1.25 mg/L of Levaquin 6 hours after the dosing.
- Breast milk concentration of 0.64 mg/L of Levaquin 9 hours after the dosing.
- Breast milk concentration of 0.29 mg/L of Levaquin 12 hours after the dosing.
- Breast milk concentration of 0.06 mg/L of Levaquin 24 hours after the dosing.
The results of the study suggest that if you do breastfeed while taking Levaquin, you should do it as far apart from dosing as possible, at least 4 to 6 hours afterwards as that will be the time past which maximum concentrations are seen.
To summarize:
- Levaquin is excreted in the breast milk, but in low concentrations.
- The dose of Levaquin an infant would be exposed to is far less than what has been seen to cause joint disorders in children and adolescents.
- If you do take Levaquin while breastfeeding, do so as far apart from dosing as possible as breast milk concentrations of the drug decrease quickly starting from 2 hours after dosing.
Are There Safer Alternative Therapies?
Be sure to speak with your doctor regarding the risks and benefits of using Levaquin (levofloxacin) for your infection if you have been prescribed it and are nursing. There may be other alternatives, influding:
- Sulfamethoxazole; trimethoprim
- Ceftazidime
- Ceftriaxone
- Cefepime
- Piperacillin; tazobactam
There are many factors that go into choice of antibiotic therapy while breastfeeding (e.g. site of infection, microbial susceptibility etc...) and a discussion between you are your doctor is the best way to find the optimal therapy for your specific situation.
