Is Metronidazole (Dermal and Vaginal use) compatible with breastfeeding? Do we have alternatives for Metronidazole (Dermal and Vaginal use)?

Metronidazole (Dermal and Vaginal use)

August 29, 2018 (Very Low Risk)

Metronidazole is used topically in the treatment of acne (Kong 2013) and vaginitis.

Metronidazole, taken orally, is excreted in small amounts in breast milk (Zhang 1997, Passmore 1988, Heisterberg 1983, Erickson 1981, Gray 1961) and does not cause problems in infants (Passmore 1988, Gray 1961).

The low content of topical preparations (<1% metronidazole) and its poor absorption through skin or vaginal mucosa makes it unlikely that it reaches in a significant amount to breast milk.
Compared with oral administration, the plasma levels reached are 1% through the skin and 2% vaginally (AEMPS 2018, Sanofi 2018, FDA 2005, AEMPS 2001) being even more compatible with breastfeeding than systemic administration (Rowe 2013, Kong 2013).

See below the information of this related product:


We do not have alternatives for Metronidazole (Dermal and Vaginal use) since it is relatively safe.

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.


  • Metronidazole Ovules
  • Metronidazole Vaginal Gel


  1. AEMPS-Meda. Metronidazol vaginal. Ficha técnica. 2018 Full text (in our servers)
  2. Sanofi. Metronidazole (cream). Drug Summary. 2018 Full text (in our servers)
  3. Kong YL, Tey HL. Treatment of acne vulgaris during pregnancy and lactation. Drugs. 2013Abstract
  4. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. 2013Abstract
  5. FDA-Teva. Metronidazole (Vaginal). Drug Summary. 2005 Full text (in our servers)
  6. AEMPS-Galderma. Metronidazol Gel. Ficha técnica. 2001 Full text (in our servers)
  7. Zhang Y, Zhang Q, Xu Z. [Tissue and body fluid distribution of antibacterial agents in pregnant and lactating women]. Zhonghua Fu Chan Ke Za Zhi. 1997Abstract
  8. Passmore CM, McElnay JC, Rainey EA, D'Arcy PF. Metronidazole excretion in human milk and its effect on the suckling neonate. Br J Clin Pharmacol. 1988Abstract Full text (link to original source) Full text (in our servers)
  9. Heisterberg L, Branebjerg PE. Blood and milk concentrations of metronidazole in mothers and infants. J Perinat Med. 1983Abstract
  10. Erickson SH, Oppenheim GL, Smith GH. Metronidazole in breast milk. Obstet Gynecol. 1981Abstract
  11. GRAY MS, KANE PO, SQUIRES S. Further observations on metronidazole (Flagyl). Br J Vener Dis. 1961Abstract Full text (link to original source) Full text (in our servers)