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Tenofovir disoproxil fumarate

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  • Tenofovir disoproxil fumarate

    Hi there from New Zealand,

    I have a pregnant Mum on Tenofovir disoproxil fumarate, for hepatitis B. She has been advised that she cannot breastfeed once the infant is born. Medications and Mothers' Milk 2010 has the drug as an L3, with no suggested alternatives. I wondered if Dr Hale would now know of any safer alternatives or, concur with not breastfeeding on this medication. Would the foetus not recieve more via the placenta than the infant via breastmilk?

    Many thanks
    L

  • #2
    Dear L,

    Dr. Hale's recommendation for tenofovir is as follows: Tenofovir is used in the management of HIV and hepatitis B infections. It interferes with the viral RNA dependent DNA polymerase, inhibiting viral replication. In monkeys, peak levels in milk were reported to be 0.808 and 0.610 ?g/mL. Using this peak data, the relative infant dose would only be 0.4% of the maternal dose. In addition, the oral bioavailability of tenofovir (non salt form) is negligible (5%). Thus the overall risk to a breastfeeding infant would probably be low. According to Briggs et al, we do not have data on how much tenofovir crosses the placenta in humans, but it does cross in animal studies. The kinetics of the drug suggest that it would cross the placenta so likely the fetus would receive more of the drug compared to a breastfed infant, but we do not know this for sure.

    Sincerely,
    Cindy Pride, MSN, CPNP
    TTUHSC InfantRisk Center

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    • #3
      thanks really for sharing thsi info

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