Summary of Use during Lactation

No information is available on the clinical use of norfloxacin during breastfeeding; however, amounts in breastmilk appear to be low. Fluoroquinolones such as norfloxacin have traditionally not been used in infants because of concern about adverse effects on the infants' developing joints. However, more recent studies indicate little risk.[1,2] In addition, the calcium in milk might prevent absorption of the small amounts of fluoroquinolones in milk,[3] but insufficient data exist to prove or disprove this assertion. The serum and milk levels and oral bioavailability of norfloxacin are the lowest of any of the fluoroquinolones, so the risk to the infant should be minimal. Use of norfloxacin is acceptable in nursing mothers with monitoring of the infant for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash).

Drug Levels

Maternal Levels. Norfloxacin was undetectable in milk at any time up to 6 hours after a single 200 mg oral dose.[4] Milk levels have not been measured after repeated administration.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

Alternate Drugs to Consider

Ciprofloxacin, Levofloxacin, Nitrofurantoin, Trimethoprim

References

1.

van den Oever HL, Versteegh FG, Thewessen EA, et al. Ciprofloxacin in preterm neonates: Case report and review of the literature. Eur J Pediatr. 1998;157:843–5. [PubMed: 9809826]

2.

Gürpinar AN, Balkan E, Kiliç N, et al. The effects of a fluoroquinolone on the growth and development of infants. J Int Med Res. 1997;25:302–6. [PubMed: 9364293]

3.

Fleiss PM. The effect of maternal medications on breast-feeding infants. J Hum Lact 1992;8:7. Letter. PMID: 1558663. [PubMed: 1558663]

4.

Takase Z, Shirafuji H, Uchida M. Basic and clinical studies on AM-715 in the field of obstetrics and gynecology. Chemotherapy (Tokyo). 1981;29 Suppl 4:697–704.

Substance Name

Norfloxacin

CAS Registry Number

70458-96-7

Drug Class

Breast Feeding

Lactation

Anti-Infective Agents

Antibacterial Agents

Quinolones

Fluoroquinolones