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Use and safety Acyclovir for pregnant and lactating women: can it be taken during pregnancy and breastfeeding

Can acyclovir be used during pregnancy to treat herpes and possible risks to the fetus

Acyclovir belongs to a class of antiviral drugs called synthetic nucleoside analogues. It works by stopping the spread of the herpes virus in the body. Used to reduce pain and speed up the healing of sores or blisters in people with chickenpox (chickenpox), shingles, a rash that can occur in people who have had chickenpox in the past, and outbreaks of genital herpes (occasionally causes ulcers around genitals and rectum).

In a study by the Centers for Disease Control and Prevention (CDC), aciclovir was found to cross the placenta, but teratogenicity (birth defects) was not observed, but there are still insufficient data to assess the risk of less common defects or to obtain reliable or final conclusions regarding the safety of this drug during pregnancy.

According to research by the Food and Drug Administration (FDA), it was noted that women taking acyclovir for the treatment of herpes simplex, even during the first trimester of pregnancy, did not demonstrate a risk to the fetus.

The Australian Medicines Administration (AU TGA) has studied a limited number of pregnant women and women of childbearing age who have taken oral acyclovir and found that it did not increase the incidence of malformations or other direct or indirect harmful effects on the mother's fetus. Animal studies have shown an increased incidence of fetal injury, the significance of which in humans is uncertain.

The American College of Obstetricians and Gynecologists (ACOG) recommends taking aciclovir for the treatment of genital herpes, especially recurrent ones, from the 36th week of pregnancy to avoid infection of the newborn baby. But since, as a result of not multiple studies, little information has been provided about it, it is advised to use it with extreme caution, strictly according to the doctor's prescription in the exact minimum dosage indicated as soon as possible.

Information was also provided to ACOG that suppressive therapy in late pregnancy reduces the rate of caesarean section in women with recurrent genital herpes by reducing the rate of recurrence during pregnancy, but such treatment may not protect against transmission of the viral infection to the newborn in all cases .

Centers for Disease Control and Prevention (CDC) in 2015 concluded that this drug can be used to treat herpetic lesions in women at all stages of pregnancy, but under the strict supervision of a doctor, following all his prescriptions for prescribed doses, frequency and duration of administration, as well as in case of the most urgent need and, as a rule, the benefit to the mother should exceed the risk to the fetus.

Breastfeeding use of acyclovir and exposure to infants

Food and Drug Administration (FDA) studies of acyclovir use in breastfeeding women have found that it passes into breast milk, but even at the most At high maternal doses, the concentration of acyclovir in milk is only about 1% of the typical pediatric dose and is not expected to cause any side effects in breastfed infants. Local application of acyclovir to small areas of the mother's body away from the breast does not pose a risk to the infant.

As a result of maternal herpesvirus infection of the infant during pregnancy, newborns are given aciclovir at doses of 20 to 30 mg/kg intravenously daily according to the CDC. Dosages obtained in breast milk at high maternal doses are only about 3-5% of this dose. Because the infant receives oral doses of breast milk and aciclovir is only about 20% orally bioavailable, the systemic dose received by the nursing infant is 1% or less of the typical pediatric dose, resulting in no reported adverse reactions in infants.

Several cases of oral aciclovir in breastfeeding mothers have also been reported to the CDC and FDA:

• The mother of a 4-month-old infant did not notice any side effects in her breastfed infant when she took aciclovir 800 mg orally 5 times a day;

• 90,004 a woman who was 6 weeks postpartum received acyclovir 300 mg (5 mg/kg) intravenously three times a day 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 up to 88 hours after the last dose. 6 hours after the last dose, the breast-fed child received a daily dose of 1.1 mg / kg of acyclovir through mother's milk, in the case of such therapy in the mother during lactation, there were also no negative effects in the infant.

As a result of these studies, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) have concluded that aciclovir for lactating women is considered acceptable but should not be taken. uncontrolled, the dose and duration of treatment with acyclovir should be determined by the doctor, with a mandatory comparison of the benefits for the mother and the possible risks for the newborn.

Herpes during breastfeeding in a nursing mother: on the lip, chest, genital

The herpes virus is known to almost everyone. Statistics show that only 10% of the world's inhabitants are not among those infected with any of the forms of herpes. If it once appeared in the body, the risk of relapse persists throughout life, but there is a reliable barrier that keeps it - immunity. It depends on the state of the immune system how often you will observe familiar symptoms.

Contents

• 1. Varieties of herpes
  • 1.1. On the lips
  • 1.2. On the genitals
  • 1.3. Herpes zoster
• 2. Do I need to change my feeding regimen?
• 3. Treatment of herpes on the lips
• 4. Drugs for the treatment of other forms of herpes
• 5. Video on the topic of the article
• 6. Questions from readers and answers from an expert

Varieties of herpes

During breastfeeding, as you know, immunity decreases, and if at this time you are even a little overcooled, the disease can immediately make itself felt. It manifests itself in different ways, since the types of the causative agent of the disease also differ.

Herpes during breastfeeding can be:

• on the lips;
• on the genitals;
• zoster.

On the lips

Herpes on the lips - the first type of virus - the most common. It is transmitted in a domestic way, that is, through dishes, towels, etc. A small child from a nursing mother can get it through kisses.

First, redness and swelling appear on or near the lips, as well as on the wings of the nose, which are necessarily accompanied by itching. Then small bubbles begin to appear with a clear liquid inside, which, bursting, contribute to the emergence of new ones - already more numerous.

If herpes first appeared, other cold symptoms may be added - fever, general weakness and malaise. With relapses, such signs usually do not happen.

Treatment in this case will be local. The main thing is to start it immediately when the slightest redness appears. In this case, it is good to have some kind of external remedy in your first-aid kit, and if it is not available, immediately purchase it. Then you have the right to count on a quick solution to the problem. If the bubbles have already appeared, it will take longer to be treated.

On the genitals

The second type of virus causes genital herpes. To the main reason for the exacerbation (decreased immunity), another one is added - the activation of the virus in the husband. The first symptoms in this case will be similar to the common cold - chills, fever, general weakness. Obstetrician-gynecologist Nana Ordzhonikidze advises to pay close attention to the initial signs of the disease, which can easily be confusing, and only a characteristic rash that appears later will tell about the presence of an infection.

If the diagnosis is confirmed and small watery vesicles appear, they will cover the entire perineum, pubis, inner thighs and mucous membrane of the labia. They will be present even on the mucous membrane of the vagina and cervix, but only a gynecologist can detect them during examination. Another characteristic sign - severe itching - will worsen, and urination will become painful, as the bubbles will begin to burst and urine will fall into microcracks and wounds.

Treatment of genital herpes is more complicated. You will need a mandatory consultation with a gynecologist or dermatovenereologist. It is dangerous to engage in self-medication, since when prescribing it is necessary to take into account an important factor - the period of breastfeeding. As in the previous case, the sooner treatment is started, the more successful it will be.

READ ALSO: How to treat a cold while breastfeeding?

Shingles

The third type of herpes virus causes even more serious diseases - shingles, chicken pox, chicken pox. This virus is localized in the nerve endings, so the exacerbation is accompanied by itching and pain, which are the main symptoms in relapses. When the disease appears, as in the two cases described above, there is an increase in temperature and general malaise. The rash is found in the area of ​​nerve endings and quickly occupies large areas on the skin, accompanied by severe pain.

Therapist prescribes the treatment. Only local remedies like ointments and gels are indispensable here. You will need antiviral pills, which must be selected taking into account the fact that the woman is breastfeeding.

Should I change the feeding regimen?

Many doctors believe that it is better for a woman to stop breastfeeding while she is ill, but the WHO states that there is no reason for this.

There is a document (Complete List of Medical Reasons for Using Breastmilk Substitutes 2009) which states that breastfeeding is not acceptable only if the baby is HIV-infected, and also if the baby suffers from one of the two serious diseases - galactosemia or phenylketonuria. In all other cases, including herpes, it is even necessary to continue lactation.

You just have to follow the rules of hygiene. Additional measures will also be needed:

1. HB must be continued, as the activation of the virus contributes to the production of antibodies against the disease. Antibodies immediately pass into breast milk and provide the baby with protection by blocking the activity of the virus on the third to fifth day.
2. Even if rashes appear on the body, breastfeeding should be interrupted only when they have affected the skin of the nipples. In other cases - on the lips, genitals, or even with herpes zoster, the rash is not a reason to suspend or completely stop breastfeeding. If the rash is only on one breast, you can feed the baby on the other.
3. At the same time, it is necessary to carefully monitor that the child does not have contact with the affected areas of the skin on the mother's body. Herpes is transmitted by household means, so the baby must be protected in every possible way from infection. If the virus appeared on the lips, of course, there can be no question of any kisses.
4. Personal hygiene needs to be monitored more carefully than usual. Regardless of which part of the body is affected by herpes, it is necessary to wash your hands with soap as often as possible: do this before you start feeding or just pick up the baby, and also after washing or eating.

Maintaining cleanliness and good hygiene can cure the virus faster or prevent infection altogether. Cleanliness is the key to health, it is not for nothing that experts have been talking about this for many years.

Treatment of herpes on the lips

Treatment of herpes on the lips is easier than other types of the virus. The first thing to do is not to ignore the problem or procrastinate, but to take action quickly. The virus can be dealt with at the very beginning of the development of the disease, preventing it from reaching an advanced stage. The second important rule is to use local remedies (ointments, creams, gels). The concentration of active substances in them is low and, as a rule, they do not pass into breast milk. Lactation at this time should not be interrupted.

Preparations for the treatment of other forms of herpes

Genital and herpes zoster are more severe, and therefore more difficult to treat. It is necessary to act on them in a complex way, that is, to use external agents and antiviral tablets.

Despite the fact that there are enough drugs for oral administration, manufacturers in the instructions for use limit their use during lactation or recommend interrupting breastfeeding while the mother is being treated. It is useful to study the list of funds, but we advise you not to prescribe the funds yourself, but be sure to visit a doctor. Only a competent specialist will do this with minimal damage to the health of the child.

READ ALSO: treatment of the common cold during breastfeeding

Consider the most well-known and effective drugs:

1. Acyclovir (Acyclovir, Zovirax) is considered a highly effective remedy for the treatment of herpes of the first and third types. Available in the form of tablets, powder, cream and ointment.
2. Valaciclovir (Valvir, Valtrex) is a next-generation tablet after acyclovir. They are used to treat all types of herpes.
3. Penciclovir (Fenistil Pencivir) - topical (cream). Despite external use, it is recommended to use it during lactation very carefully, only if the expected benefit outweighs the potential harm to the child. Although the latest data from the E-LACTANCIA guideline states that when applied topically, the drug is not detected in blood plasma and therefore does not penetrate into breast milk, when applied to the body, care must be taken that the child does not have contact with the treated areas of the skin, and before feeding the breast should be washed thoroughly with soap.

If the immune system is weak, the doctor may prescribe additional drugs to increase immunity. These are preparations with interferon ("Viferon", "Kipferon"), produced in the form of candles.

Folk remedies for the treatment of herpes are used only as an auxiliary during remission.

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