在发达国家,不建议对感染人类免疫缺陷病毒(WLWH)的女性进行母乳喂养.然而,对于选择不母乳喂养的女性来说,泌乳症状可能令人痛苦。目前没有关于预防或减少WLWH中泌乳症状的最合适选择的通用指南。这篇综述描述了使用卡麦角林的证据基础,多巴胺能激动剂,用于产后抑制WLWH的泌乳。
使用PubMed中的搜索,对WLWH的产后药物泌乳抑制进行了范围审查,MedlineOvid,EBM评论Ovid,Embase,WebofScience和Scopus直到2019年。卡麦角林药理特性的叙述性综述,治疗效果,然后进行与泌乳抑制相关的耐受性数据和药物相互作用数据.
在1366篇文章中,范围审查确定了13种相关出版物。已经发表了八项指南,为WLWH的泌乳抑制提供了指导,并在英国发表了两项有关该主题的医学实践调查。三项研究评估了药物在WLWH中的使用。其中两项研究评估了卡麦角林,并报道它是该人群中抑制泌乳的有效方法。第三项研究评估了乙炔雌二醇和溴隐亭的使用,显示疗效较差。卡麦角林是一种长效多巴胺D2激动剂和麦角衍生物,在分娩后以1mg的单次口服剂量给予时,可以抑制催乳素分泌并抑制生理泌乳。卡麦角林至少与溴隐亭一样有效地抑制泌乳,成功率在78%至100%之间。瞬变,临床试验中描述了卡麦角林的轻度至中度不良事件。很少存在药物相互作用,因为卡麦角林既不是肝细胞色素P450同工酶的底物也不是诱导/抑制剂。在卡麦角林和包括蛋白酶抑制剂的任何抗逆转录病毒药物之间没有临床上显著的药物-药物相互作用的报道。
卡麦角林是预防非母乳喂养妇女生理性泌乳和相关身体症状的安全有效的药物选择。未来的研究应该关注它的安全性,WLWH的疗效和可接受性。
In developed countries, breastfeeding is not recommended for women living with human immunodeficiency virus (WLWH). However, lactation symptoms can be distressing for women who choose not to breastfeed. There is currently no universal guideline on the most appropriate options for prevention or reduction of lactation symptoms amongst WLWH. This review describes the evidence base for using cabergoline, a dopaminergic agonist, for the post-partum inhibition of lactation for WLWH.
A scoping review of post-partum pharmaceutical lactation inhibition specific for WLWH was conducted using searches in PubMed, Medline Ovid, EBM Reviews Ovid, Embase, Web of Science and Scopus until 2019. A narrative review of cabergoline pharmacologic properties, therapeutic efficacy, tolerability data and drug interaction data relevant to lactation inhibition was then conducted.
Among 1366 articles, the scoping review identified 13 relevant publications. Eight guidelines providing guidance regarding lactation inhibition for WLWH and two surveys of medical practice on this topic in UK have been published. Three studies have evaluated the use of pharmaceutical agents in WLWH. Two of these studies evaluated cabergoline and reported it to be an effective method of lactation inhibition in this population. The third study evaluated ethinyl estradiol and bromocriptine use and showed poor efficacy. Cabergoline is a long-acting dopamine D2 agonist and ergot derivative that inhibits prolactin secretion and suppresses physiologic lactation when given as a single oral dose of 1 mg after delivery. Cabergoline is at least as effective as bromocriptine for lactation inhibition with success rates between 78% and 100%. Transient, mild to moderate adverse events to cabergoline are described in clinical trials. Few drug interactions exist as cabergoline is neither a substrate nor an inducer/inhibitor of hepatic cytochrome P450 isoenzymes. There are no reported clinically significant drug-drug interactions between cabergoline and any antiretroviral medications including protease inhibitors.
Cabergoline is a safe and effective pharmacologic option for the prevention of physiological lactation and associated physical symptoms in non-breastfeeding women. Future studies should focus on its safety, efficacy and acceptability among WLWH.