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Is use of nifurtimox for the treatment of Chagas disease compatible with breast feeding? A population pharmacokinetics analysis
  1. Facundo Garcia-Bournissen1,
  2. Jaime Altcheh2,
  3. Alice Panchaud3,
  4. Shinya Ito1
  1. 1Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Canada
  2. 2Division of Parasitology, Hospital de Niños Buenos Aires, Argentina
  3. 3Swiss Teratogen Information Service, University Hospital, Lausanne, Switzerland
  1. Correspondence to Facundo Garcia-Bournissen, Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, University of Toronto, 555 University Avenue, 8th Floor, Black Wing, Room 8232, Toronto, ON M5G 1X8, Canada; facundo.garciabournissen{at}


Introduction Women with Chagas disease receiving treatment with nifurtimox are discouraged from breast feeding. Many patients who would receive treatment with nifurtimox live in extreme poverty, have limited access to resources such as clean water and baby formula and may not have safe alternatives to breast milk.

Aim We aimed to estimate, using limited available pharmacokinetics data, potential infant exposure to nifurtimox through breast milk.

Methods Original nifurtimox plasma concentrations were obtained from published studies. Pharmacokinetic parameters were estimated using non-linear mixed-effect modelling with NONMEM V.VI. A total of 1000 nifurtimox plasma–concentration profiles were simulated and used to calculate the amount of drug that an infant would be exposed to, if breast fed 150 ml/kg/day.

Results Breast milk concentrations on the basis of peak plasma levels (1361 ng/ml) and milk–plasma ratio were estimated. We calculated infant nifurtimox exposure of a breastfed infant of a mother treated with this drug to be below 10% of the maternal weight-adjusted dose, even if milk–plasma ratio were overestimated. Simulation led to similar estimates.

Discussion Risk for significant infant exposure to nifurtimox through breast milk seems small and below the level of exposure of infants with Chagas disease receiving nifurtimox treatment. This potential degree of exposure may not justify discontinuation of breast feeding.

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  • Funding FGB has received funding from the Clinician Scientist Training Programme. This programme is funded, fully or in part, by the Ontario Student Opportunity Trust Fund – Hospital for Sick Children Foundation Student Scholarship Programme.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.