The amounts of systemically administered tacrolimus are low in breastmilk and do not adversely affect the breastfed infant. Tacrolimus has been used extensively by nursing mothers and United States and European experts guidelines consider tacrolimus to be acceptable during breastfeeding.[1-3] Exclusively breastfed infants should be monitored if this drug is used during lactation, possibly including measurement of serum levels to rule out toxicity if there is a concern.
Topical tacrolimus presents a low risk to the nursing infant because it is poorly absorbed after topical application and peak blood concentrations are less than 2 mcg/L in most patients. Ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Current guidelines allow topical tacrolimus to be applied to the nipples just after nursing, with the nipples cleaned gently before nursing.[4,5] Only water-miscible cream or gel products should be applied to the breast or nipple because ointments may expose the infant to high levels of mineral paraffins via licking,[5] so pimecrolimus cream may be preferable to tacrolimus ointment for nipple application.