Saccharomyces boulardii: Risk of fungaemia


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Saccharomyces boulardii is a live yeast used as a probiotic. Previously, Saccharomyces boulardii -containing products have been contraindicated in patients with central venous catheter (CVC) due to the risk of fungaemia.

In November 2017, the European Medicines Agency (EMA) had concluded that the risk of using Saccharomyces boulardii- containing products in critically ill or immunocompromised patients outweighs the potential benefit due to the risk of fungaemia1. According to the latest Periodic Safety Update Report (PSUR) of Saccharomyces boulardii, a total of 61 cases of fungaemia have been reported cumulatively, while the EudraVigilance database revealed a total of ten (10) fatal cases of fungaemia/fungal infection and sepsis associated with administration of S. boulardii containing products. Following this, it is in the opinion of EMA that an update of the product information of Saccharomyces boulardii containing products is warranted.

NPRA has conducted a safety review on the risk of fungaemia with the use Saccharomyces boulardii containing products and concluded that the product packaging information must be updated to include information on this risk.


Adverse Drug Reaction Reports:

To date, no ADR report associated with the use of Saccharomyces boulardii -containing products has been received by NPRA2.


Advice for Healthcare Professionals:


A directive [Ruj. Kami: (23) dlm. BPFK/PPP/07/25 Jld. 2] has been issued by NPRA for updates to the local product packaging insert and consumer medication information leaflet (Risalah Maklumat Ubat untuk Pengguna) related to this safety issue. Please refer to the directive for more information.



  1. European Medicines Agency (2018). Saccharomyces boulardii - CMDh Scientific conclusions and grounds for the variation to the terms of the Marketing Authorisation(s).
  2. The Malaysian Adverse Drug Reaction Database, NPRA [Accessed: August 2018].



This publication is aimed at health professionals. The information is meant to provide updates on medication safety issues, and not as a substitute for clinical judgement. While reasonable care has been taken to verify the accuracy of the information at the time of publication, the NPRA shall not be held liable for any loss whatsoever arising from the use of or reliance on this publication.