毒理性
哺乳期使用概要:齐多夫定在哺乳期间已被充分研究。乳汁中药物水平较低,大多数哺乳的婴儿血液中检测不到药物水平。一些哺乳的婴儿在母亲接受治疗期间出现了贫血。在美国和其他可以获取清洁水源和负担得起的替代喂养的国家,建议HIV阳性母亲不要哺乳,以避免HIV-1感染的后天性传播。通过抗逆转录病毒治疗实现并维持病毒载量抑制,可以将哺乳传播风险降低到1%以下,但并非零。对于选择哺乳的、接受抗逆转录病毒治疗且病毒载量持续不可检测的HIV阳性个体,应支持他们的这一决定。
对哺乳婴儿的影响:一项研究将孕妇随机分配接受单用齐多夫定或高效抗逆转录病毒治疗(HAART:齐多夫定、拉米夫定和奈韦拉平)以预防母婴传播HIV感染。分娩后,所有婴儿接受了一个月的齐多夫定预防治疗;一些婴儿被哺乳,而其他婴儿则接受配方奶喂养。与未暴露组相比,HAART暴露组在1个月大时中性粒细胞减少的婴儿比例更高(分别为15.9%和3.7%)。血液学毒性是短暂的且无症状的。在产后2到6个月期间,哺乳和配方奶喂养的婴儿之间在血液学毒性方面没有差异。哺乳和配方奶喂养的婴儿在肝脏毒性方面没有统计学差异。
一项研究比较了三组接受齐多夫定产后预防治疗以预防母婴传播HIV感染的婴儿中严重贫血的发生率。在6个月大之前,接受HAART的母亲哺乳的婴儿严重贫血的发生率(7.4%)高于仅接受齐多夫定的母亲哺乳的婴儿(5.3%)。配方奶喂养的婴儿严重贫血的发生率最低(2.5%)。贫血通常对铁剂和多种维生素补充以及停用齐多夫定反应良好。
对哺乳和乳汁的影响:截至修订日期,没有找到相关的已发布信息。
◉ Summary of Use during Lactation:Zidovudine has been well studied during breastfeeding. Milk levels are low and most breastfed infants do not have detectable blood levels. Some breastfed infants have developed anemia during maternal therapy. In the US and other countries where access to clean water and affordable replacement feeding are available, it is recommended that mothers living with HIV not breastfeed their infants to avoid postnatal transmission of HIV-1 infection. Achieving and maintaining viral suppression with antiretroviral therapy decreases breastfeeding transmission risk to less than 1%, but not zero. Individuals with HIV who are on antiretroviral therapy with a sustained undetectable viral load and who choose to breastfeed should be supported in this decision.
◉ Effects in Breastfed Infants:A study assigned pregnant women to zidovudine alone or highly-active antiretroviral therapy (HAART: zidovudine, lamivudine and nevirapine) to prevent maternal-to-child transmission of HIV infection. After delivery, all infants received one month of zidovudine prophylaxis; some infants were breastfed and others were formula fed. A higher percentage of infants in the HAART-exposed group had neutropenia than those in the unexposed group at 1 month of age (15.9% and 3.7%, respectively). Hematologic toxicity was transient and asymptomatic. From 2 to 6 months postpartum, no differences in hematologic toxicity were seen between breastfed and formula-fed infants. No statistical difference in hepatic toxicity was seen between the breastfed and formula-fed infants.
A study compared the rates of severe anemia in 3 groups of infants who received postpartum prophylaxis with zidovudine for prevention of maternal-to-child transmission of HIV infection. Through 6 months of age, breastfed infants whose mothers received HAART had a higher rate of severe anemia (7.4%) than breastfed infants whose mothers received only zidovudine (5.3%). Formula-fed infants had the lowest rate of severe anemia (2.5%). The anemia generally responded well to iron and multivitamin supplementation, and discontinuation of zidovudine.
◉ Effects on Lactation and Breastmilk:Relevant published information was not found as of the revision date.
来源:Drugs and Lactation Database (LactMed)