Dr. Newman's All-Purpose Nipple Ointment (APNO)

Information and How to Use APNO

Pharmacist putting ointment in a jar
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Nipple pain is a common problem that breastfeeding mothers face. It's not only uncomfortable, but it's one of the top reasons women decide to stop breastfeeding and wean early. But, with effective treatment breastfeeding can be more comfortable, allowing women to continue to breastfeed longer and more successfully. One treatment option is All-Purpose Nipple Ointment. 

What Is All-Purpose Nipple Ointment? 

All-Purpose Nipple Ointment (APNO) is the creation of Dr. Jack Newman, a leading breastfeeding researcher and founder of the International Breastfeeding Centre in Canada.

APNO is one of the most popular nipple-healing and infection-fighting compounds that breastfeeding mothers use. This triple nipple ointment is made up of three ingredients: an antibiotic, an anti-inflammatory, and an anti-fungal. 

What APNO Is Used to Treat

Sore nipples can develop for many reasons, and there are different treatments depending on the cause. Dr. Jack's All-Purpose Nipple Ointment helps to soothe and heal sore nipples that may arise from:

How to Make APNO: The Recipe

All Purpose Nipple Ointment is a custom medication that requires a prescription. If, after you speak to your doctor and have an exam, the doctor believes this medication can help, she can provide you with a detailed prescription. Certain pharmacies, known as compounding pharmacies, can prepare this ointment for you.

You can also make the mixture yourself, but you still need a prescription.

  • The antibiotic: Bactroban (mupirocin) 2% ointment (not cream): 15 grams. You'll need to get a prescription from your doctor for this ingredient. If mupirocin is not available, bacitracin can be used although it is not as effective. An antibiotic helps to heal nipple pain by stopping the growth of bacteria.  Preventing the growth of bacteria on the nipples can also help protect against mastitis.  
  • The anti-inflammatory: Betamethasone 0.1% ointment (not cream): 15 grams. You can get this by prescription or over-the-counter. Betamethasone is a corticosteroid. It eases nipple pain by reducing any swelling caused by injury, infection, or skin irritation. 
  • The anti-fungal: Miconazole powder, so that the final concentration is 2% miconazole. Miconazole is preferred, but 2% clotrimazole powder or 15 grams of Nystatin ointment are acceptable substitutes if miconazole is not available. The use of an anti-fungal powder over an ointment will result in a better concentration of the antifungal agent (miconazole or clotrimazole), and the concentrations of the mupirocin and betamethasone will remain higher. This medication is available by prescription or over-the-counter. The anti-fungal ingredient in this recipe fights off Candida. Candida is the yeast that causes the fungal infection called thrush
  • Sometimes it is helpful to add ibuprofen powder as well so that the final concentration of ibuprofen is 2%. 
  • Combine all the ingredients in equal parts. Once the mixture is complete, it should yield a total volume of approximately 30 grams or 1 ounce of APNO.

How to Use Your APNO

Apply a tiny amount of your APNO mixture to your nipples and areola after each breastfeeding session.

You do not need to wash this ointment off before the next feeding. However, you should only be using a very small amount, so it will not harm your baby.  

You should begin to see (and feel) results within a few days, but you can continue to use the ointment for two to three weeks if it's needed. But, keep in mind, it is a medication, so you want to use it for the least amount of time as possible. If your condition does not improve in two to three weeks, you should go back to see your doctor. The doctor can reevaluate the situation and discuss other treatment options.

How to Use APNO Along With Gentian Violet

Gentian violet is an over-the-counter product that is used to treat thrush.

It is found in natural food stores and can be used as a combination treatment along with APNO. The recommended way to follow this combination treatment is as follows:

Use gentian violet once a day for 3 or 4 days. Take a cotton swab and dip it into a 0.5 to 1% solution of gentian violet (do not use a solution greater than 1%). Spread a small amount of the gentian violet around the nipple and areola on one side and let it dry. It should only take a couple of seconds. Then, breastfeed on that side. Do the same thing on the other side. After the feeding is complete, you can reapply a tiny amount over the nipples. Remember, you only need a drop, and it's only once a day.

Use APNO for all other feedings. Do not use APNO for the feeding that you apply gentian violet. Apply APNO after every other feeding during the day. 

Using gentian violet may be messy, and it will turn your breasts and your baby's mouth purple. But, when it's used with APNO, it can help to relieve nipple pain and heal thrush in just a few days. If you don't feel better in a week, stop using gentian violet and see your doctor. 

A Word From Verywell

Breastfeeding shouldn't hurt. There may be a little tenderness when your baby first latches on, especially during the first few weeks, but it shouldn't last the entire feeding, and it should get better as the days and weeks go on. If your nipples become so sore that you begin to dread breastfeeding, something is not right. Once breastfeeding becomes painful, get help. Don't wait to find out what's going on and begin treatment. The sooner you can feel more comfortable and get back to breastfeeding, the better it will be for you and your baby. 

Sources:

Heller MM, Fullerton‐Stone H, Murase JE. Caring for new mothers: diagnosis, management, and treatment of nipple dermatitis in breastfeeding mothers. International journal of dermatology. 2012 Oct 1;51(10):1149-61.

Kent JC, Ashton E, Hardwick CM, Rowan MK, Chia ES, Fairclough KA, Menon LL, Scott C, Mather-McCaw G, Navarro K, Geddes DT. Nipple pain in breastfeeding mothers: incidence, causes, and treatments. International journal of environmental research and public health. 2015 September 29; 12(10):12247-63.

Lawrence, Ruth A., MD, Lawrence, Robert M., MD.  Breastfeeding A Guide For The Medical Profession Eighth Edition. Elsevier Health Sciences. 2015.

McClellan HL, Hepworth AR, Garbin CP, Rowan MK, Deacon J, Hartmann PE, Geddes DT. Nipple pain during breastfeeding with or without visible trauma. Journal of Human Lactation. 2012 November; 28(4):511-21.

Newman J, Pitman T. Dr. Jack Newman's guide to breastfeeding. Collins; 2014.

 

Edited by Donna Murray

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