Is Rifampin Safe in Breastfeeding

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

It is excreted into breast milk in clinically non-significant amount, in fact a much lower amount than the dose used for the treatment or prophylaxis of infection in neonates and infants. Even more, no problems that would be attributable to rifampicin have been observed among infants whose mothers were taking this medication. It can cause an orange discoloration of body fluids, including the mother’s milk.Take into account possible negative results in bacterial cultures of febrile infants, when their mothers are on antibiotics. American Academy of Pediatrics states that it is usually compatible with breastfeeding medication.WHO List of Essential Medicines 2002: compatible with breastfeeding.

Limited information indicates that there are low levels of rifampin in breastmilk that would not be expected to cause any adverse effects in breastfed infants. The amount of rifampin in milk is insufficient to treat tuberculosis in the breastfed infant. The Centers for Disease Control and Prevention and other professional organizations state that breastfeeding should not be discouraged in women taking rifampin.[1][2][3]

One woman taking rifampin 450 mg, isoniazid 300 mg and ethambutol 1200 mg daily during pregnancy and rifampin 450 mg and isoniazid 300 mg for the first 7 months of lactation (extent not stated). The infant was born with mildly elevated serum liver enzymes which persisted for to 1 (alanine transferase) to 2 years (aspartate transaminase), but had no other adverse reactions.[6] Rifampin was used as part of multi-drug regimens to treat 2 pregnant women with multidrug-resistant tuberculosis throughout pregnancy and postpartum. Their two infants were breastfed (extent and duration not stated). At age 3.9 and 5.1 years, the children were developing normally except for hyperactivity in one.[7] Two mothers in Turkey were diagnosed with tuberculosis at the 30th and 34th weeks of pregnancy. They immediately started isoniazid 300 mg, rifampin 600 mg, pyridoxine 50 mg daily for 6 months, plus pyrazinamide 25 mg/kg and ethambutol 25 mg/kg daily for 2 months. Both mothers breastfed their infants (extent not stated). Their infants were given isoniazid 5 mg/kg daily for 3 months prophylactically. Tuberculin skin tests were negative after 3 months and neither infant had tuberculosis at 1 year of age. No adverse effects of the drugs were mentioned.[8] A woman with leprosy took clofazimine, dapsone and rifampin during pregnancy and breastfeeding. Her infant developed skin discoloration attributed to clofazimine which reversed 3 months after cessation of breastfeeding.[9]