Objective
Women in the postpartum period are at high risk for complications from influenza.
Pharmacokinetic data of oseltamivir phosphate in postpartum women, however, are lacking.
Study Design
Seven healthy patients within 48 hours of delivery were recruited. Each woman received
75 mg of oseltamivir phosphate. Plasma and breast milk samples were obtained at times
0, 0.5, 1, 2, 4, 8, 12, and 24 hours after the first dose. The samples were analyzed
for oseltamivir and oseltamivir carboxylate levels. Using a noncompartmental model,
area under the curve (AUC), maximum concentration (Cmax), time to maximum concentration, and half-life were estimated.
Results
Oseltamivir phosphate and oseltamivir carboxylate were found in breast milk, although
later and in lower levels than that found in plasma. The Cmax and AUC 0-24 was higher for the active metabolite than for the prodrug in both plasma
and breast milk.
Conclusion
Oseltamivir carboxylate was present in breast milk but in concentrations significantly
lower than considered therapeutic in infants.
Key words
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References
- H1N1 2009 influenza virus infection during pregnancy in the USA.Lancet. 2009; 374: 451-458
- Pandemic influenza and pregnant women: summary of a meeting of experts.Am J Public Health. 2009; 99: 248-253
- 2009 H1N1 influenza A and pregnancy outcomes in Victoria, Australia.Clin Infect Dis. 2010; 50: 686-690
- Severe 2009 H1N1 influenza in pregnant and postpartum women in California.N Engl J Med. 2010; 362: 27-35
- Interim report on pandemic H1N1 influenza virus infections in South Africa, April to October 2009: epidemiology and factors associated with fatal cases.Euro Surveill. 2009; 14 (Accessed Oct. 1, 2010)
- Factors associated with death or hospitalization due to pandemic 2009 influenza A (H1N1) infection in California.JAMA. 2009; 302: 1896-1902
- Pandemic 2009 influenza A (H1N1) virus illness amount pregnant women in the United States.JAMA. 2010; 303: 1517-1525
- Severity of 2009 pandemic influenza A (H1N1) virus infection in pregnant women.Obstet Gynecol. 2010; 115: 717-726
- Novel influenza A (H1N1) virus among gravid admissions.Arch Intern Med. 2010; 170: 10868-10873
- 2009 Pandemic influenza A (H1N1) in pregnant women requiring intensive care—New York City, 2009.MMWR Morb Mortal Wkly Rep. 2010; 59: 321-325
- Updated interim recommendations for obstetric health care providers related to use of antiviral medications in the treatment and prevention of influenza for the 2009-2010 season.(Accessed June 4, 2010)
- Active metabolite from Tamiflu® solution is bioequivalent to that from capsule delivery in healthy volunteers: a cross-over, randomized, open-label study.Vaccine. 2006; 24: 6660-6663
- Similarity in pharmacokietnics of oseltamivir and oseltamivir carboxylate in Japanese and Caucasian subjects.J Clin Pharmacol. 2007; 47: 689-696
- Clinical pharmacokinetics of the prodrug oseltamivir and its active metabolie Ro 64-0802.Clin Pharmacokinet. 1999; 37: 471-484
- The pharmacokinetics and tolerability of the oral neuraminidase inhibitor oseltamivir (Ro 64-0796/GS4104) in healthy adult and elderly volunteers.J Clin Pharmacol. 2000; 40: 836-843
- Pharmacokinetics of oseltamivir: an oral antiviral for the treatment and prophylaxis of influenza in diverse populations.J Antimicrob Chemother. 2010; 65: ii5-ii10
- Oseltamivir and breastfeeding.Int J Infect Dis. 2008; 12: 451
- Safety of oseltamivir compared with the adamantanes in children less than 12 months of age.Pediatr Infect Dis J. 2010; 29: 195-198
- Tamiflu oseltamivir phosphate: product information, 2004.(Accessed May 1, 2010)
Article Info
Publication History
Published online: April 01, 2011
Accepted:
January 26,
2011
Received in revised form:
November 19,
2010
Received:
October 4,
2010
Footnotes
Cite this article as: Greer LG, Leff RD, Rogers VL, et al. Pharmacokinetics of oseltamivir in breast milk and maternal plasma. Am J Obstet Gynecol 2011;204:524.e1-4.
This study was supported in part by the Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, and by Grant no. 5-U10-HD046000-05 from the National Institutes of Health supporting the Pediatric Pharmacology Research Unit Network.
Reprints not available from the authors.
Identification
Copyright
© 2011 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
