Опоясывающий лишай и лактация

[TimSvet]

Доброго времени суток, уважаемые консультанты! Случилась такая беда -опоясывающий лишай, пока обхожусь без таблеток, но они нужны...поэтому спрашиваю вашего совета. Принимать нужно таблетки ацикловира(ацикловир, валацикловир, гевиран и т.д.), но они несовместимы с ГВ, как выкрутиться? Сыну будет 1 год - 21 июля. Кушает очень часто, без груди пока не представляю как он будет, еду со стола кушает тоже хорошо, соски нету... Надо ли прекращать ГВ, я готова сцеживаться, как в таком случае плавно перевести малыша на чашку/соску? Спасибо за ваши ответы.

 

[Лариса Коланда]

По базе данных при Государственной Медицинской Библиотеке США, Лактмед
http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT.htm
ацикловир и аналоги (валацикловир..) совместимы с ГВ. Проведенные исследования показали его безопасность для ребенка при приеме и наружно, и внутрь. Можете воспользвоаться он-лайн переводчиком Гугла, он вполне корректно переводит эти материалы

Drug Levels and Effects:


Summary of Use during Lactation:
Even with the highest maternal dosages, the dosage of acyclovir in milk is only about 1% of a typical infant dosage and would not be expected to cause any adverse effects in breastfed infants. Topical acyclovir applied to small areas of the mother's body away from the breast should pose no risk to the infant. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.[1]


Drug Levels:
Maternal Levels. A 4-month-postpartum women was taking 200 mg orally 5 times daily every 4 hours while awake. After 4 days of therapy, milk samples were taken 9 hours after the previous dose and at 4 times after a 200 mg dose. The lowest milk level of 427 mcg/L occurred 30 minutes after the first dose. At 3.2 hours after the dose, the milk acyclovir level was 1.3 mg/L and apparently still increasing.[2]

A woman who was 1 year postpartum was taking acyclovir 200 mg orally 5 times daily. Milk levels taken immediately before a dose during 5 days of therapy ranged from 0.78 to 1.07 mg/L. Samples taken after the last dose decreased with a half-life of 2.8 hours.[3]

A woman who had taken oral acyclovir 400 mg 3 times daily for 3 days in the peripartum period had a breastmilk acyclovir level of 54 mcg/L 5 days after her last dose of acyclovir.[4] A mother nursing her 7-month-old infant took acyclovir 800 mg orally 5 times a day. Three milk acyclovir levels on days 5 and 6 of therapy ranged from 4.2 to 5.8 mg/L, with the highest level 9.4 hours after the previous dose. The authors estimated that a fully breastfed infant would receive 0.73 mg/kg/day of acyclovir at this maternal dosage or about 1% of the maternal weight-adjusted dosage.[5]

A woman who was 6 weeks postpartum received intravenous acyclovir 300 mg (5 mg/kg) 3 times daily for 5 days. Milk samples were taken every 6 hours after the last dose. The peak level was 7.3 mg/L and the drug was detectable in milk for up to 88 hours after the last dose.[6] Using the level 6 hours after the last dose, a fully breastfed infant would receive 1.1 mg/kg/day with this maternal dosage regimen.

Acyclovir is given to neonates in intravenous dosages of 20 to30 mg/kg daily. Dosages received in breastmilk with high maternal doses are only about 3 to 5% of this dose. Because the infant receives breastmilk doses orally and acyclovir is only about 20% orally bioavailable,[5] the systemic dosage that the nursing infant receives is 1% or less of a typical infant dosage.

Infant Levels. A 4-month-old infant whose mother was taking 200 mg orally 5 times was breastfed just before a dose. The infant's urine collected over the next 2 hours contained a total of 27 mcg of acyclovir.[2]


Effects in Breastfed Infants:
The mother of a 4-month-old infant noticed no adverse effects in her breastfed infant while she was taking an acyclovir dosage of 800 mg orally 5 times daily.[5]


Possible Effects on Lactation:
Relevant published information was not found as of the revision date.

Валацикловир

Summary of Use during Lactation:
The dosage of acyclovir in milk after valacyclovir is less than 1% of a typical infant dosage and would not be expected to cause any adverse effects in breastfed infants. No special precautions are required.


Drug Levels:
Valacyclovir is a prodrug that is rapidly converted to acyclovir in the body.

Maternal Levels. Five mothers who were nursing neonates were given valacyclovir 500 mg orally every 12 hours for 5 days. Valacyclovir was not detected in milk. Median peak acyclovir concentrations in milk of 4.2 mg/L occurred at 2 to 4 hours after the first dose and was similar after the last dose. The authors calculated the median milk concentration at steady-state to be 2.24 mg/L. The median half-life in milk was 2.1 hours (range 1.3 to 12.2 hours).[1] Using the median milk levels from this study, an exclusively breastfed infant would receive 0.34 mg/kg daily by mouth with this regimen, which is less than 1% of dosage given to neonates.

Infant Levels. The urine of 5 infants whose mothers were taking valacyclovir 500 mg every 12 hours orally was collected. Valacyclovir was not detected in any of the infant's urine. The median infant urine acyclovir concentration on day 5 of therapy was 0.74 mg/L.[1]


Effects in Breastfed Infants:
Relevant published information was not found as of the revision date.


Possible Effects on Lactation:
Relevant published information was not found as of the revision date.