替诺福韦 服药可以母乳吗&新人报道

wangxinghao

回复 csfluke 的帖子

确实 官网上确实有写到不建议母乳 但这样一来越来越迷惑 为什么会有不少声音说可以母乳 尤其国外医生！好挣扎啊

StephenW

回复 wangxinghao 的帖子

替诺福韦 服药可以母乳

Breastfeeding while taking lamivudine or tenofovir disoproxil fumarate: a review of the evidence

    Stephan Ehrhardt1,*, Chan Xie2,*, Nan Guo1, Kenrad Nelson1,3,4, and Chloe L. Thio3,5

+
Author Affiliations

    1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
    2Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
    3Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
    4Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
    5Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America

    For correspondence: Chloe L. Thio, MD, Professor of Medicine, Johns Hopkins University, 855 N Wolfe St, Suite 520, Baltimore, MD 21205, Ph: 410-614-6088, Email: [email protected]

    ↵* These authors contributed equally to this work.

Abstract

Lamivudine and tenofovir disoproxil fumarate (TDF) are both active against hepatitis B virus (HBV). Due to its potency, high genetic barrier to resistance, and safety during pregnancy, TDF may be useful to prevent HBV transmission from mother-to-child, which is the leading cause of transmission globally. Despite the safety record of lamivudine and TDF in pregnancy, the labels for both of these drugs recommend against their use during breastfeeding. In this review, we discuss the data regarding lamivudine and TDF use during pregnancy and breastfeeding and find that the exposure to the drug is lower from breastfeeding than from in utero exposure. Thus, the data do not support the contraindication to their use during breastfeeding.
同时服用拉米夫定或富马酸替诺福韦酯母乳喂养：证据的审查

    斯蒂芬Ehrhardt1，*，陈Xie2，*，南果1，Kenrad Nelson1,3,4，和Chloe L. Thio3,5

+
作者机构

    流行病学教研室的，公共卫生，马里兰州巴尔的摩，美国约翰霍普金斯大学彭博学院
    传染病教研室，第三附属医院孙中山大学，广州市，广东省，中国
    3Division传染病，医学，约翰霍普金斯大学，巴尔的摩，MD，美国系
    国际卫生，公共卫生约翰霍普金斯大学彭博学院，马里兰州巴尔的摩，美国的4Department
    分子微生物学和免疫学，公共卫生约翰霍普金斯大学彭博学院，马里兰州巴尔的摩，美国的5Department

    对于信件：克洛伊L.硫代，医学博士，医学教授，美国约翰霍普金斯大学，855Ñ沃尔夫街，520套房，马里兰州巴尔的摩21205，电话：410-614-6088，电邮：[email protected]

    ↵*这些作者贡献同样对这项工作。

抽象

拉米夫定和富马酸替诺福韦酯（TDF）都是积极的抗乙型肝炎病毒（HBV）。由于其在怀孕期间效力，高耐药基因屏障，安全，TDF可能是有用的，以防止乙肝病毒母婴传播给孩子，这是全球性传播的主要原因。尽管拉米夫定和TDF在怀孕的安全记录，对于这两种药物的标签建议对哺乳期间它们的使用。在这次审查中，我们讨论有关拉米夫定和TDF利用这些数据在怀孕和哺乳期间，如果发现暴露于药物较低母乳喂养不是从子宫内暴露。因此，该数据不哺乳期间支持禁忌其使用。

StephenW

回复 wangxinghao 的帖子

"In a hepatitis B virus real-life cohort, tenofovir treatment during pregnancy was well-tolerated, including in patients treated from the first trimester. No safety issues were reported for breastfeeding while on tenofovir up to 1 year," Stern told MedPage Today, at the American Association for the Study of Liver Diseases meeting.

“在乙肝病毒现实生活中的人群，在怀孕期间替诺福韦治疗耐受性良好，包括从孕早期治疗的患者，没有安全问题的报道进行母乳喂养，而在替诺福韦长达1年，”斯特恩告诉MedPage今天，在为肝病会议研究的美国协会。

happy099

回复 StephenW 的帖子

没明白，到底是支持替诺母乳还是不支持？

wangxinghao

In this review, we discuss the data regarding lamivudine and TDF use during pregnancy and breastfeeding and find that the exposure to the drug is lower from breastfeeding than from in utero exposure. Thus, the data do not support the contraindication to their use during breastfeeding.
这句总结句，表示哺乳里的乳汁的暴露要少于子宫里的，这些数据不能支持禁止哺乳。

wangxinghao

回复 StephenW 的帖子

弱弱的问下，这篇资料是什么时候的呢？有权威性吗？

StephenW

回复 wangxinghao 的帖子

2015 January.
有权威性吗?有, 美国和中国医生


http://www.drugs.com/breastfeeding/tenofovir.html
Tenofovir Levels and Effects while Breastfeeding

Summary of Use during Lactation

Limited published experience with tenofovir during breastfeeding in HIV-positive mothers and HIV-negative mothers treated for hepatitis B infection indicates that the exposure of the infant to the drug is trivial. A few infants have been breastfed during maternal tenofovir therapy and no adverse effects have been seen. An expert review of available data concluded that there is currently no justification for contraindicating the use of tenofovir for hepatitis B during breastfeeding.[1]

In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through 12 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine.[2][3]

wangxinghao

StephenW 发表于 2015-8-7 12:34
回复 wangxinghao 的帖子

2015 January.

确实让人兴奋！
但国内不少医生还是明确表示不建议母乳，不乏一些专家态度！着实让人有些无法坚定！

happy099

替诺的说明书上好像说乳汁中有药物分泌，不过也提到怀孕期间要谨慎用药，但是我们怀孕期间都用了药呢

wangxinghao

回复 wangxinghao 的帖子

有多少宝妈是带药母乳呢？分享下经验吧