No information is available on the use of atovaquone and proguanil during breastfeeding. The Centers for Disease Control and Prevention does not currently recommend it for the prevention of malaria in women breastfeeding infants weighing less than 5 kg (11 pounds). However, it can be used for treatment of women who are breastfeeding infants of any weight when the potential benefit outweighs the potential risk to the infant (e.g., treating a breastfeeding woman who has acquired P. falciparum malaria in an area of multidrug-resistant strains and who cannot tolerate other treatment options).[1]
In general, very small amounts of antimalarial drugs are excreted in the breast milk of lactating women. Because the quantity of antimalarial drugs transferred in breast milk is insufficient to provide adequate protection against malaria, infants who require chemoprophylaxis must also receive the recommended dosages of antimalarial drugs.[1]