Is Miconazole Safe in Breastfeeding

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

Excretion into breast milk is highly unlikely due to an almost nil systemic absorption through the skin, vaginal mucosa and even the intestine, with non-significant plasma levels (< 1 mcg/ mL) observed. In case of use on the nipple, let it be done after the feed and wipe it out any excess of cream before the next feed. Do not apply creams, gels and other products that would contain paraffin (mineral oil) to avoid absorption by the infant since it is a hydrocarbon-derived substance. Miconazole has not been found to be more effective than pure lanolin for treatment of sore or cracked nipples. List of Essential Medicines by WHO 2002: compatible with breastfeeding.

Because miconazole has poor oral bioavailability, it is unlikely to adversely affect the breastfed infant, including topical application to the nipples. However, miconazole ointment appears to have no advantage over lanolin for treating sore nipples during breastfeeding[1] and a survey of members of the Academy of Breastfeeding Medicine found topical miconazole is rarely prescribed to nursing mothers to treat thrush.[2] Any excess cream or ointment should be removed from the nipples before nursing. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.[3]

In a randomized, double-bind trial, lanolin was compared to an all-purpose nipple ointment containing mupirocin 1%, betamethasone 0.05%, and miconazole 2% for painful nipples while nursing in the first 2 weeks postpartum. The two treatments were equally effective in reducing nipple pain, nipple healing time, breastfeeding duration, breastfeeding exclusivity rate, mastitis and nipple symptoms, side effects or maternal satisfaction with treatment.[1]