毒理性
◉ 母乳喂养期间使用总结:阿巴卡韦在母乳中以小量出现。关于其在哺乳期使用的安全性信息非常有限。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,建议感染HIV的母亲不要母乳喂养婴儿,以避免HIV-1感染的后天传播。通过抗逆转录病毒治疗实现并维持病毒载量抑制,可以将母乳传播风险降低到1%以下,但并非零。在抗逆转录病毒治疗下病毒载量持续不可检测的HIV感染者如果选择母乳喂养,应该支持这一决定。
◉ 对哺乳婴儿的影响:一位HIV阳性母亲每天服用一次含有多替拉韦50毫克、硫酸阿巴卡韦600毫克和拉米夫定300毫克(特鲁迈克)的复合片剂。她的婴儿大约纯母乳喂养了30周,又部分母乳喂养了大约20周。未观察到明显的副作用。
◉ 对泌乳和母乳的影响:在接受高效抗逆转录病毒治疗的男性中报告了男性乳房发育。男性乳房发育最初是单侧的,但在大约一半的病例中进展为双侧。未观察到血清催乳素的变化,即使在继续用药的情况下,通常也会在一年内自发解决。一些病例报告和体外研究建议蛋白酶抑制剂可能会导致一些男性患者出现高催乳素血症和乳汁分泌过多,尽管这一点存在争议。这些发现与哺乳母亲的相关性尚不清楚。已建立泌乳的母亲催乳素水平可能不会影响她的哺乳能力。
◉ Summary of Use during Lactation:Abacavir appears in breastmilk in small quantities. Very little information is available on the safety of its use during breastfeeding. 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:An HIV-positive mother took a combination tablet containing dolutegravir 50 mg, abacavir sulfate 600 mg and lamivudine 300 mg (Triumeq) once daily. Her infant was exclusively breastfed for about 30 weeks and partially breastfed for about 20 weeks more. No obvious side effects were noted.
◉ Effects on Lactation and Breastmilk:Gynecomastia has been reported among men receiving highly active antiretroviral therapy. Gynecomastia is unilateral initially, but progresses to bilateral in about half of cases. No alterations in serum prolactin were noted and spontaneous resolution usually occurred within one year, even with continuation of the regimen. Some case reports and in vitro studies have suggested that protease inhibitors might cause hyperprolactinemia and galactorrhea in some male patients, although this has been disputed. The relevance of these findings to nursing mothers is not known. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.
来源:Drugs and Lactation Database (LactMed)