Is Abacavir sulfate Safe in Breastfeeding

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

Anti-HIV drug which is indicated for children older than 3 mo. The amount excreted into breast milk is minimal. Plasma levels have failed to be found in breastfed infants of treated women Mothers must be adviced that transmission of HIV infection by breastfeeding has been documented. However, mothers treated with Abacavir sulfate are at lower risk of HIV transmission through breastfeeding.

In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. Published experience with Abacavir sulfate during breastfeeding is limited. 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 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.[5]

Gynecomastia has been reported among men receiving highly active antiretroviral therapy. Gynecomastia is unilateral initially, but progresses to bilateral in about half of cases. No alterations in serum prolactin were noted and spontaneous resolution usually occurred within one year, even with continuation of the regimen.[6][7][8] Some case reports and in vitro studies have suggested that protease inhibitors might cause hyperprolactinemia and galactorrhea in some male patients,[9][10] although this has been disputed.[11] The relevance of these findings to nursing mothers is not known. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.