Is Dolutegravir Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Dolutegravir? Is Dolutegravir safe for nursing mother and child? Does Dolutegravir extracts into breast milk? Does Dolutegravir has any long term or short term side effects on infants? Can Dolutegravir influence milk supply or can Dolutegravir decrease milk supply in lactating mothers?

Dolutegravir is detectable in maternal milk and infant plasma during breastfeeding. It appears that elimination by newborn infants is prolonged. In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. No published information is available on the use of dolutegravir during breastfeeding. 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 at least 12 months of life up to 24 months of life.[1] 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]

An HIV-positive mother took a combination tablet containing dolutegravir 50 mg, abacavir sulfate 600 mg and lamivudine 300 mg (Triumeq) once daily. Her infant was exclusively breastfed for about 30 weeks and partially breastfed for about 20 weeks more. No obvious side effects were noted.[4] A study that randomized nursing mothers to anti-HIV regimens containing either dolutegravir (n = 29) or efavirenz (n = 31), the regimens were reportedly well tolerated by the infants and no difference in infant adverse reactions were noted between the two regimens.[6]