Population pharmacokinetic modelling of primaquine exposures in lactating women and breastfed infants
Issued Date
2024-12-01
Resource Type
eISSN
20411723
Scopus ID
2-s2.0-85192385408
Journal Title
Nature Communications
Volume
15
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
Nature Communications Vol.15 No.1 (2024)
Suggested Citation
Wattanakul T., Gilder M.E., McGready R., Hanpithakpong W., Day N.P.J., White N.J., Nosten F., Tarning J., Hoglund R.M. Population pharmacokinetic modelling of primaquine exposures in lactating women and breastfed infants. Nature Communications Vol.15 No.1 (2024). doi:10.1038/s41467-024-47908-y Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/98345
Title
Population pharmacokinetic modelling of primaquine exposures in lactating women and breastfed infants
Author's Affiliation
Corresponding Author(s)
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Abstract
Current guidelines advise against primaquine treatment for breastfeeding mothers to avoid the potential for haemolysis in infants with G6PD deficiency. To predict the haemolytic risk, the amount of drug received from the breast milk and the resulting infant drug exposure need to be characterised. Here, we develop a pharmacokinetic model to describe the drug concentrations in breastfeeding women using venous, capillary, and breast milk data. A mother-to-infant model is developed to mimic the infant feeding pattern and used to predict their drug exposures. Primaquine and carboxyprimaquine exposures in infants are <1% of the exposure in mothers. Therefore, even in infants with the most severe G6PD deficiency variants, it is highly unlikely that standard doses of primaquine (0.25-1 mg base/kg once daily given to the mother for 1-14 days) would cause significant haemolysis. After the neonatal period, primaquine should not be restricted for breastfeeding women (Clinical Trials Registration: NCT01780753).