All-purpose nipple ointment, usually shortened to APNO, is a compounded preparation associated with Dr. Jack Newman, a Canadian physician known for his work in breastfeeding medicine. It combines three medicines in one ointment and is prescribed for sore, cracked, or damaged nipples during breastfeeding.
It is prescription-only and it is compounded, because no manufacturer makes this combination. Its use for nipple soreness is off-label, and compounded preparations are not FDA-approved or reviewed by the FDA for safety or effectiveness. Whether it is appropriate for you is a decision for your prescriber or lactation consultant, not for a pharmacy and not for an article.
One thing is worth saying at the top. Nipple pain during breastfeeding is most often a latch or positioning problem, so an assessment by a lactation consultant comes before, or alongside, any ointment. Bayview prepares all-purpose nipple ointment only on a prescriber's order.
What is in all-purpose nipple ointment?
Bayview compounds APNO as mupirocin 1% / betamethasone 0.05% / miconazole 2%. Ratios vary between prescribers and pharmacies, so yours may differ.
Each ingredient addresses a different possible contributor to nipple damage. Mupirocin is a topical antibiotic active against staphylococcal species, which commonly colonise cracked skin. Betamethasone is a topical corticosteroid, included to reduce inflammation. Miconazole is an antifungal, included because Candida is sometimes involved in persistent nipple pain.
Combining them means one preparation covers several possibilities at once. It also means the ointment contains a corticosteroid, and that is worth knowing rather than glossing over: topical steroids are used for defined periods, not indefinitely, and your prescriber sets that period.
| Ingredient | Drug class | Reason included | Status |
|---|---|---|---|
| Mupirocin 1% | Antibiotic | Bacterial colonisation | Off-label |
| Betamethasone 0.05% | Corticosteroid | Inflammation | Off-label |
| Miconazole 2% | Antifungal | Suspected Candida | Off-label |
The third column describes why a prescriber includes each ingredient, not what any of them will do for you. The combination is not FDA-approved, and applying these three drugs to nipple skin is an off-label use of all three.
Betamethasone is one of several topical corticosteroids a prescriber can specify, and compounded triamcinolone is another that Bayview prepares to order.
The combination is also not the only shape this can take. Where a prescriber wants a single antifungal rather than three drugs together, compounded nystatin is prepared in several dose forms.
Which drugs, which strengths, and how many days of use are the prescriber's decisions, not a pharmacy's and not a patient's. A compounding pharmacy prepares what is written on the prescription and answers questions about the preparation itself.
Is there a best nipple cream for breastfeeding?
No single product is right for everyone, because nipple pain is not one problem. Over-the-counter nipple balms, creams and hydrogel pads are sold without a prescription and are chosen by the person using them.
All-purpose nipple ointment is different in kind. It is a prescription combination of three drugs, prepared by a compounding pharmacy to a prescriber's order, and its use on nipples is off-label. It is not an upgraded version of a shelf product and it is not interchangeable with one.
Which of these is appropriate, and whether anything topical is called for at all, follows from an assessment rather than from a product comparison. No cream changes how a baby is latched. If pain has lasted more than a few days, the assessment is the step with more in it.
Why does nipple pain need a cause and not just an ointment?
This is the part most articles leave out. Nipple pain during breastfeeding usually has an underlying cause, and an ointment treats the damage rather than the cause.
Latch and positioning are the most common contributors. Tongue-tie, vasospasm, thrush, eczema, and mastitis all present differently and are managed differently. If pain persists, worsens, or comes with fever, spreading redness, or a lump, contact your provider rather than continuing to apply an ointment. A lactation consultant is often the fastest route to identifying what is actually happening.
An IBCLC, an International Board Certified Lactation Consultant, watches a full feed and assesses the latch directly. That is something no product and no article can do. Hospitals, pediatric practices and public health programs are the usual places to find one.
The list below is not a diagnosis and is not a checklist to work through at home. It is there to show how differently these causes are assessed, which is the reason the assessment comes first.
| Possible cause | Type | First assessment |
|---|---|---|
| Latch or positioning | Mechanical | Lactation consultant |
| Tongue tie | Anatomical | Lactation consultant |
| Vasospasm | Vascular | Prescriber |
| Bacterial infection | Infection | Prescriber |
| Candida | Infection | Prescriber |
| Dermatitis or eczema | Skin | Prescriber |
Where the picture is a skin one rather than an infection, a prescriber may choose a different topical altogether, such as compounded tacrolimus, which is used off-label on the skin. That is a prescribing decision made after an examination.
Our post on dermatology compounding covers how topical preparations are put together, and where the published evidence for them is thin.
How is all-purpose nipple ointment used?
Follow the directions on your label and from your prescriber. A common direction is a small amount applied sparingly to the affected area after feeds, for a defined number of days, with a review if things have not improved.
A question that comes up constantly is whether it needs to be wiped off before the baby feeds. Dr. Newman's protocol does not call for removing it. Practice varies, and since the preparation contains a corticosteroid and an antibiotic, this is exactly the question to put to your prescriber or lactation consultant and follow their answer rather than a general rule found online.
Use only the amount directed, for the period directed. More ointment does not resolve the problem faster, and prolonged use of a topical steroid on this skin is not the intent of the preparation.
Store it as the label directs and note the beyond-use date printed on it. If anything on the label is unclear, call and ask a pharmacist rather than working it out yourself.
Compounded preparations are made in small batches for one named patient, so a jar is not a general household item. It is not shared with anyone else, and it is not carried on into a later pregnancy or a later baby without a new prescription.
What should you tell your prescriber?
Tell your prescriber about any allergy to mupirocin, corticosteroids, or antifungals, about any other creams or ointments you are applying to the same area, and about anything else you are taking. Stop and contact them if you develop increasing redness, burning, a rash, or any reaction that concerns you.
No topical preparation is free of the possibility of a reaction, and anyone who tells you otherwise is overstating it. Report anything unexpected.
Anything involving your baby, including questions about feeding while the ointment is on the skin, belongs to your prescriber and your lactation consultant. They know your history and your baby's. Ask them directly and follow what they tell you.
Why is it compounded, and how do you order it?
No manufacturer makes a mupirocin, betamethasone, and miconazole combination, so a compounding pharmacy has to prepare it. Details of the preparation are on our mupirocin, betamethasone and miconazole page.
Bayview is a 503A compounding pharmacy in Warwick, Rhode Island, and prepares each order in small batches under USP standards against a prescription written for a named patient. Prescribers can e-prescribe to Bayview Pharmacy, 3844 Post Rd, Warwick, RI 02886, or fax 401-284-4506; account setup is covered on our for providers page. If you already hold a prescription and have a question about it, a Bayview pharmacist is glad to help.
What Bayview compounds for this: an all-purpose nipple ointment prepared as topical mupirocin 1% / betamethasone 0.05% / miconazole 2%, in USP 795 non-sterile compounding, from $77, on a prescriber's order. Other ratios and strengths are prepared when a prescriber specifies them.
Compounded preparations are not billed through insurance, so this is a cash price. Questions about cost, refills, and the states where Bayview is licensed are answered on our FAQ page.
The preparation sits with our women's health preparations, alongside items such as vaginal estriol and vulvodynia creams.
Two things that come up in the same conversation are worth separating. Compounded oxytocin, described in our post on oxytocin and its compounded forms, is a different preparation with its own prescribing considerations and is not used for nipple pain.
Everything Bayview prepares is listed in the searchable catalog of compounded medications, by category and by drug.
If compounded prescriptions are new to you, our post on how a compounding pharmacy differs from a retail pharmacy explains why a preparation like this cannot be picked off a shelf.
Talk to your prescriber about whether this preparation fits your situation, and ask for a lactation assessment if you have not had one. Those two conversations decide more than any product choice does.
Frequently asked questions
What is this triple cream?
A compounded topical cream that combines mupirocin (antibacterial), betamethasone (a steroid that calms inflammation), and miconazole (antifungal) in one preparation. No commercial product combines all three, so it is compounded and prescription-only.
What is it used for?
Providers may prescribe it for rashes thought to involve bacteria, fungus, and inflammation together, such as skin-fold rashes (intertrigo), dermatitis with a suspected infection, or some diaper rashes. These uses are provider-determined and often off-label.
How do I apply it?
Apply a thin layer to the affected skin as your provider directs. Avoid the eyes, nose, and mouth, and do not cover or bandage the area unless told to, since covering skin increases how much medication is absorbed.
Is it safe to use for a long time?
Because it contains a steroid, providers usually limit how much, how large an area, and how long it is used. Long-term use, especially on the face, in skin folds, or under coverings, can thin the skin. Use only as directed.
Can I use it on my child?
Extra caution applies in children and infants, where more steroid can be absorbed. Only use it on a child if a provider has prescribed it for them, and follow their instructions closely.
When should I call my provider?
Contact your provider if the rash worsens or spreads, is not improving within the expected treatment window, or develops signs of a new infection such as increasing warmth, swelling, or drainage. Seek care promptly for signs of an allergic reaction like hives, facial swelling, or trouble breathing. When in doubt, call.
Are compounded medications FDA-approved?
Compounded medications are not FDA-approved. They're prepared by a licensed pharmacy pursuant to a valid prescription for an individual patient, under USP standards. The FDA does not review compounded medications for safety or effectiveness.
Do I need a prescription?
Yes. All of our medications require a valid prescription from a licensed provider. We're a dispensing and compounding pharmacy, so we don't provide consultations or write prescriptions. If you don't have one yet, you'll need to find and see a provider first.
Can I use a compounded medication while pregnant or breastfeeding?
That decision belongs to you and your prescriber, and it has to be made for your specific medication and situation rather than from a general rule.
Some compounded preparations are used routinely during pregnancy and lactation. Others contain ingredients that are avoided. And a few carry handling precautions that matter even when you are not the person taking the medication — certain hormone creams, for instance, can transfer through skin contact.
Tell your prescriber and our pharmacists if you are pregnant, trying to become pregnant, or breastfeeding before you start a new compounded medication. Our pharmacists are glad to review your formulation and talk it through with your prescriber. Call us at 401-284-4505.
How do I report a side effect or a problem with my medication?
Call us at 401-284-4505 or email info@bayviewrx.com. Tell us which medication it is, when the problem started and what you noticed. Our pharmacists document every report, review the preparation, and contact your prescriber when the situation calls for it.
Please tell your prescriber as well — they may want to adjust the therapy, and they are the one who can.
You can also report a side effect directly to the FDA through MedWatch, its voluntary reporting program. Reporting to the FDA does not replace telling us and your prescriber, but it does help build the safety picture for compounded preparations generally.
If the reaction is severe, get emergency care first and tell us afterward.
How should I store my compounded medication?
Always follow the storage instructions printed on your label. They are specific to your preparation and they override any general advice, including this answer.
Most compounded medications are stored at controlled room temperature, roughly 68 to 77 °F, in the original container with the cap closed tightly, away from heat, direct light and moisture. A bathroom cabinet is usually a poor choice because of the humidity. Some preparations must be refrigerated, and the label will say so. Do not freeze a medication unless the label tells you to, and never warm one in a microwave.
Every compounded preparation carries a beyond-use date on the label. That date is assigned under USP standards and reflects how long the preparation is expected to stay stable. Do not use it past that date, even if there is medication left in the container.
Keep all medications out of reach of children and pets. Controlled substances should be stored secured and out of sight. If you are not sure how to store something, call us at 401-284-4505.
How much do compounded medications cost?
Pricing varies depending on ingredients and formulation complexity.
Do you accept insurance?
Most compounded medications are not covered by insurance. We can always try and run your insurance prior to compounding your prescription if you wish.
What Bayview compounds for this
Important: Compounded medications are prepared to a prescriber's order for an individual patient. They are not FDA-approved, and the FDA has not evaluated them for safety, effectiveness, or manufacturing quality. This article is educational and is not a substitute for advice from your prescriber or pharmacist.
This preparation contains a controlled substance. Controlled-substance prescriptions carry refill limits, must be e-prescribed, and can only be shipped to states where Bayview holds the required licensure.
Uses discussed here may be off-label, meaning they are not part of any FDA-approved labeling. Off-label use is a decision for you and your prescriber, based on the available evidence.
Veterinary preparations are compounded to a veterinarian's order for a specific animal and are not FDA-approved animal drugs. Never give a compounded human medication to an animal without veterinary direction.
Compounded prescriptions are paid for directly rather than billed through insurance. Most are HSA/FSA-eligible, and many patients submit the receipt to their plan for possible reimbursement. Pricing depends on the strength, dose form and quantity your prescriber orders. Read more about cost and insurance.
All-purpose nipple ointment is prepared to order and starts at $77. Compounded preparations are not billed through insurance, so this is a cash price paid at the pharmacy. A receipt for your own records is available on request, and questions about cost and refills are answered on our FAQ page.
Bayview Pharmacy is an NABP-accredited compounding pharmacy in Warwick, Rhode Island, licensed to fill and ship compounded prescriptions for patients in Rhode Island, Massachusetts, Connecticut, New Jersey, New Hampshire, Florida, New York and Maine. Controlled substances are not shipped to New York addresses. See where we ship and how to get started.
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