The Basics
What is Sulfadoxine and Pyrimethamine?
Combination medication used to treat malaria. It contains sulfadoxine and pyrimethamine.
Brand names for Sulfadoxine and Pyrimethamine
Fansidar
How Sulfadoxine and Pyrimethamine is classified
Anti-Infective Agents, Antiparasitic Agents, Antimalarials, Antiprotozoal Agents, Sulfonamides
Sulfadoxine and Pyrimethamine During Pregnancy
Sulfadoxine and Pyrimethamine pregnancy category
Category CNote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Sulfadoxine and Pyrimethamine while pregnant
N/A
Taking Sulfadoxine and Pyrimethamine While Breastfeeding
What are recommendations for lactation if you're taking Sulfadoxine and Pyrimethamine?
Because there is little published experience with sulfadoxine during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. The manufacturer states that the combination of sulfadoxine-pyrimethamine is contraindicated for prophylaxis during nursing and in children under 2 months of age. However, some authors have found no contraindication to the use of sulfadoxine-pyrimethamine during breastfeeding.[1][2] It has been suggested that maternal pyrimethamine clearance might be increased during lactation, but data are insufficient to make a definitive conclusion.[3][4] Sulfadoxine-pyrimethamine prophylaxis of the mother should be discontinued at the first appearance in the infant of jaundice, skin rash, if a significant reduction in the count of any formed blood elements is noted, or upon the occurrence of active bacterial or fungal infections.
Maternal / infant drug levels
Because there is little published experience with sulfadoxine during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. The manufacturer states that the combination of sulfadoxine-pyrimethamine is contraindicated for prophylaxis during nursing and in children under 2 months of age. However, some authors have found no contraindication to the use of sulfadoxine-pyrimethamine during breastfeeding.[1][2] It has been suggested that maternal pyrimethamine clearance might be increased during lactation, but data are insufficient to make a definitive conclusion.[3][4] Sulfadoxine-pyrimethamine prophylaxis of the mother should be discontinued at the first appearance in the infant of jaundice, skin rash, if a significant reduction in the count of any formed blood elements is noted, or upon the occurrence of active bacterial or fungal infections.
Possible effects of Sulfadoxine and Pyrimethamine on milk supply
Relevant published information was not found as of the revision date.
Possible alternatives to Sulfadoxine and Pyrimethamine
Chloroquine, Mefloquine.
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. Peters PJ, Thigpen MC, Parise ME, Newman RD. Safety and toxicity of sulfadoxine/pyrimethamine: implications for malaria prevention in pregnancy using intermittent preventive treatment. Drug Saf. 2007;30:481-501. PMID: 17536875
2. Chattopadhyay R, Mahajan B, Kumar S. Assessment of safety of the major antimalarial drugs. Expert Opin Drug Saf. 2007;6:505-21. PMID: 17877439
3. Salman S, Davis TME. Regarding Lactation Status and Studies of Pyrimethamine Pharmacokinetics in Pregnancy . CPT Pharmacometrics Syst Pharmacol. 2017;6:730. PMID: 29064165
4. de Kock M, Tarning J, Barnes KI, Denti P. Response to Lactation Status and Studies of Pyrimethamine Pharmacokinetics in Pregnancy . CPT Pharmacometrics Syst Pharmacol. 2017;6:731. PMID: 29052341
5. Clyde DF. An examination of factors involved in the transfer of pyrimethamine in human milk. East Afr Med J. 1957;34:81-5. PMID: 13437933
6. Clyde DF, Press J, Shute GT. Transfer of pyrimethamine in human milk. J Trop Med Hyg. 1956;59:277-84. PMID: 13385913
7. Clyde DF. Prolonged malaria prophylaxis through pyrimethamine in mothers’ milk. East Afr Med J. 1960;37:659-60. PMID: 13694157
8. Semrau K, Kuhn L, Kasonde P et al. Impact of chloroquine on viral load in breast milk. Trop Med Int Health. 2006;11:800-3. PMID: 16772000
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
