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

Ganciclovir

September 19, 2016 (Low Risk)

Synthetic nucleoside which is analogue of guanine, structurally very closed related to acyclovir.
Indicated for the treatment and prevention of Cytomegalovirus (CMV) in immunocompromised patients.

At latest update no published data on excretion into breast milk were found.

It is used in newborns and premature who are affected with CMV infection.
Its low oral bioavailability hinders the passage from ingested milk towards the infant’s plasma, except in preterm babies and immediate neonatal period, which may show an increased intestinal permeability.

Alternatives

We do not have alternatives for Ganciclovir.

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.

Synonyms

  • Dihydroxypropoxymethylguanine (DHPG)

Writings

  • غانسيكلوفير (Arabic)
  • Ганцикловир (Cyrillic)
  • 更昔洛韦 (Chinese)
  • ガンシクロビル (Japanese)
  • C9H13N5O4 (Molecular formula)

Drug trade names

References

  1. Mehler K, Oberthuer A, Lang-Roth R, Kribs A. High rate of symptomatic cytomegalovirus infection in extremely low gestational age preterm infants of 22-24 weeks' gestation after transmission via breast milk. Neonatology. 2014Abstract
  2. Lombardi G, Garofoli F, Manzoni P, Stronati M. Breast milk-acquired cytomegalovirus infection in very low birth weight infants. J Matern Fetal Neonatal Med. 2012Abstract Full text (link to original source) Full text (in our servers)
  3. Okulu E, Akin IM, Atasay B, Ciftçi E, Arsan S, Türmen T. Severe postnatal cytomegalovirus infection with multisystem involvement in an extremely low birth weight infant. J Perinatol. 2012Abstract
  4. Alarcón Allen A, Baquero-Artigao F; Grupo de estudio de la infección por citomegalovirus de la Sociedad Española de Infectología Pediátrica. [Review and guidelines on the prevention, diagnosis and treatment of post-natal cytomegalovirus infection]. An Pediatr (Barc). 2011Abstract
  5. Radi S, Janvresse C, Lardennois C, Michel C, Brossard V, Marret S. [Breastfeeding and Cytomegalovirus infection in preterm infants. How to reduce the risks?]. Arch Pediatr. 2007Abstract
  6. Whitley RJ, Cloud G, Gruber W, Storch GA, Demmler GJ, Jacobs RF, Dankner W, Spector SA, Starr S, Pass RF, Stagno S, Britt WJ, Alford C Jr, Soong S, Zhou XJ, Sherrill L, FitzGerald JM, Sommadossi JP. Ganciclovir treatment of symptomatic congenital cytomegalovirus infection: results of a phase II study. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. J Infect Dis. 1997Abstract
  7. Anderson RD, Griffy KG, Jung D, Dorr A, Hulse JD, Smith RB. Ganciclovir absolute bioavailability and steady-state pharmacokinetics after oral administration of two 3000-mg/d dosing regimens in human immunodeficiency virus- and cytomegalovirus-seropositive patients. Clin Ther. 1995Abstract
  8. Spector SA, Busch DF, Follansbee S, Squires K, Lalezari JP, Jacobson MA, Connor JD, Jung D, Shadman A, Mastre B, et al. Pharmacokinetic, safety, and antiviral profiles of oral ganciclovir in persons infected with human immunodeficiency virus: a phase I/II study. AIDS Clinical Trials Group, and Cytomegalovirus Cooperative Study Group. J Infect Dis. 1995Abstract
  9. Trang JM, Kidd L, Gruber W, Storch G, Demmler G, Jacobs R, Dankner W, Starr S, Pass R, Stagno S, et al. Linear single-dose pharmacokinetics of ganciclovir in newborns with congenital cytomegalovirus infections. NIAID Collaborative Antiviral Study Group. Clin Pharmacol Ther. 1993Abstract
  10. Sommadossi JP, Bevan R, Ling T, Lee F, Mastre B, Chaplin MD, Nerenberg C, Koretz S, Buhles WC Jr. Clinical pharmacokinetics of ganciclovir in patients with normal and impaired renal function. Rev Infect Dis. 1988Abstract
  11. Jacobson MA, de Miranda P, Cederberg DM, Burnette T, Cobb E, Brodie HR, Mills J. Human pharmacokinetics and tolerance of oral ganciclovir. Antimicrob Agents Chemother. 1987Abstract