Is Sulphadoxyne-pyrimethamine Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Sulphadoxyne-pyrimethamine? Is Sulphadoxyne-pyrimethamine safe for nursing mother and child? Does Sulphadoxyne-pyrimethamine extracts into breast milk? Does Sulphadoxyne-pyrimethamine has any long term or short term side effects on infants? Can Sulphadoxyne-pyrimethamine influence milk supply or can Sulphadoxyne-pyrimethamine decrease milk supply in lactating mothers?

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.

Administration of pyrimethamine to mothers of 26 predominantly breastfed infants 2 to 6 months old who were infected with malaria was curative in the infants.[6] The regimen consisted of 75 mg followed by a subsequent dose of 50-75 mg 4 to 7 days later. The efficacy apparently is related to breastfeeding habits, because infants in another tribal group who breastfed their infants less extensively were not protected.[5] An additional case report indicates that a maternal dose of 75 mg orally followed by 25 mg weekly cured malaria in her infant and protected her breastfed infant against becoming infected with malaria for 6 months.[7] No adverse effects were reported in any of the infants. A study of women with HIV infection being treated for presumptive malaria included 12 nursing mothers who were taking the sulfadoxine-pyrimethamine combination. The drug combination appeared to reduce breastmilk viral load less than chloroquine treatment. No mention was made of the effects in breastfed infants.[8]