Is Emtricitabine compatible with breastfeeding? Do we have alternatives for Emtricitabine?

Emtricitabine

September 22, 2017 (Very Low Risk)

Nucleoside and nucleotide analog reverse-transcriptase inhibitors (NRTI) (Ribera 2011).

It is excreted in breast milk in small quantities (Mugwanya 2016, Benaboud 2011), much lower (200 times less) than the dose used in newborns and infants (Mugwanya 2016). The dosage in infants older than 3 months is 6 mg/kg/day and half from birth to that age (Ribera 2011).

No problems have been observed in infants whose mothers were taking it, except for mild diarrhea in 4% of cases (Mugwanya 2016), so its use in breastfeeding mothers is considered safe for both HIV treatment and pre-exposure prophylaxis (Mugwanya 2017, Seidman 2017).

The WHO recommends the so-called B+ option (highly active antiretroviral therapy - HAART) for all pregnant or breastfeeding women diagnosed with HIV, irrespective of their clinical status and CD4 count, continuing during breastfeeding and without interruption for life. Breastfeeding should be exclusive for 6 months and continue for 12 to 24 months along with complementary feeding (WHO 2016).

The recommended HAART combination is tenofovir + lamivudine or emtricitabine + efavirenz daily.
The infant, irrespective of the type of breastfeeding, should take nevirapine or zidovudine daily for 6 weeks (WHO 2016).

Most countries in the world have adopted these recommendations which date from 2013 (Nelson 2014).

Alternatives

We do not have alternatives for Emtricitabine since it is relatively safe.

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Writings

  • إيمتريسيتابين (Arabic)
  • Эмтрицитабин (Cyrillic)
  • 恩曲他滨 (Chinese)
  • エムトリシタビン (Japanese)
  • Emtricitabine (French)
  • C8H10FN3O3S (Molecular formula)
  • 5-Fluoro-1-[(2R,5S)-2-(hydroxymethyl)-1,3-oxathiolan-5-yl]cytosine (Chemical name)
  • FTC (Abbreviation)

Drug trade names

References

  1. Mugwanya KK, John-Stewart G, Baeten J. Safety of oral tenofovir disoproxil fumarate-based HIV pre-exposure prophylaxis use in lactating HIV-uninfected women. Expert Opin Drug Saf. 2017Abstract
  2. Seidman DL, Weber S, Cohan D. Offering pre-exposure prophylaxis for HIV prevention to pregnant and postpartum women: a clinical approach. J Int AIDS Soc. 2017Abstract Full text (link to original source) Full text (in our servers)
  3. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. 2016Abstract Full text (link to original source) Full text (in our servers)
  4. Mugwanya KK, Hendrix CW, Mugo NR, Marzinke M, Katabira ET, Ngure K, Semiyaga NB, John-Stewart G, Muwonge TR, Muthuri G, Stergachis A, Celum CL, Baeten JM. Pre-exposure Prophylaxis Use by Breastfeeding HIV-Uninfected Women: A Prospective Short-Term Study of Antiretroviral Excretion in Breast Milk and Infant Absorption. PLoS Med. 2016Abstract Full text (link to original source) Full text (in our servers)
  5. UNICEF. Updates on HIV and Infant Feeding: The Duration of Breastfeeding, and Support from Health Services to Improve Feeding Practices Among Mothers Living with HIV. Guideline. 2016Abstract Full text (link to original source) Full text (in our servers)
  6. Nelson LJ, Beusenberg M, Habiyambere V, Shaffer N, Vitoria MA, Montero RG, Easterbrook PJ, Doherty MC. Adoption of national recommendations related to use of antiretroviral therapy before and shortly following the launch of the 2013 WHO consolidated guidelines. AIDS. 2014Abstract
  7. Hirnschall G, Harries AD, Easterbrook PJ, Doherty MC, Ball A. The next generation of the World Health Organization's global antiretroviral guidance. J Int AIDS Soc. 2013Abstract Full text (link to original source) Full text (in our servers)
  8. Ribera E, Tuset M, Martín M, del Cacho E. [Characteristics of antiretroviral drugs]. Enferm Infecc Microbiol Clin. 2011Abstract
  9. Benaboud S, Pruvost A, Coffie PA, Ekouévi DK, Urien S, Arrivé E, Blanche S, Théodoro F, Avit D, Dabis F, Tréluyer JM, Hirt D. Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan, Cote d'Ivoire, in the ANRS 12109 TEmAA Study, Step 2. Antimicrob Agents Chemother. 2011Abstract Full text (link to original source) Full text (in our servers)