what is this rash?

[willow5]

If you have to stop you might have to express then do you have a pump I couldn't get bugger all by hand or with the hand pump, I borrowed an electric from my sister which was heaps better. I think you can hire them from some chemists or hospitals even.

[NicNac]

Bummer it's shingles Calluna. I didn't realise you were BF- maybe you could ask Barb about it through one of the bf forums.
Hope you find at least a temporary solution to your dilemma.

[willow5]

Bummer it's shingles Calluna. I didn't realise you were BF- maybe you could ask Barb about it through one of the bf forums.

Good idea and is it MadB who's up with BF too? or is it someone else grrr I hate it when I can't remember

[Calluna]

Yep, MadB is very knowledgeable. I'll do that now.
I couldn't find the aba list. :/

I've never been able to express. Maybe I'll just hand express to take the edge off and keep it moving.

[Calluna]

Would apo-valaciclovir be the same as valacyclovir?

[Little Chicken]

from the manufacturer's product info, from MIMs online

Use in Lactation
Lactating rats given a 25 mg/kg PO dose of 14C-valaciclovir showed peak milk radioactivity levels of 26
μg/eq/g, 2 hours post dose. The milk radioactivity levels declined slower than in plasma, and were
undetectable at 12 hours. Suckling pups had radioactivity in the stomach and intestinal contents up to 7
hours post dose, but not in tissues.
Limited data show that aciclovir does pass into human breast milk. In a study conducted on 5 women,
following oral administration of a 500 mg dose of valaciclovir, peak aciclovir concentrations (Cmax) in
breast milk ranged from 0.5 to 2.3 (median 1.4) times the corresponding maternal aciclovir serum
concentrations. The aciclovir AUC was 2.2 times (range 1.4 to 2.6) higher in breast milk compared to
maternal serum. In other studies, conducted with oral aciclovir administration, aciclovir had been detected
in breast milk at concentrations ranging from 0.6 to 4.1 times the corresponding aciclovir plasma
concentration. Caution is therefore advised if Valaciclovir is to be administered to a breast-feeding
mother. Valaciclovir should only be administered to breast-feeding mothers if the benefits to the mother
outweigh the potential risks to the baby

and from lactmed

Summary of Use during Lactation:
The dosage of acyclovir in milk after valacyclovir is less than 1% of a typical infant dosage and would not be expected to cause any adverse effects in breastfed infants. In one study, administration of valacyclovir to mothers with concurrent herpes simplex type 2 and HIV infections reduced breastmilk shedding of the HIV virus in breastmilk at 6 and 14 weeks postpartum, but not later.[1] No special precautions are required when using valacyclovir during breastfeeding.


Drug Levels:
Valacyclovir is a prodrug that is rapidly converted to acyclovir in the body.

Maternal Levels. Five mothers who were nursing neonates were given valacyclovir 500 mg orally every 12 hours for 5 days. Valacyclovir was not detected in milk. Median peak acyclovir concentrations in milk of 4.2 mg/L occurred at 2 to 4 hours after the first dose and was similar after the last dose. The authors calculated the median milk concentration at steady-state to be 2.24 mg/L. The median half-life in milk was 2.1 hours (range 1.3 to 12.2 hours).[2] Using the median milk levels from this study, an exclusively breastfed infant would receive 0.34 mg/kg daily by mouth with this regimen, which is less than 1% of dosage given to neonates.

In a study of pregnant women with concurrent HIV and Herpes simplex infections, mothers received zidovudine 300 mg daily from week of pregnancy until 12 months postpartum and nevirapine at delivery. Half of the women (n = 74) also received valacyclovir 500 mg orally twice daily from 34 weeks gestation until 12 months postpartum. Milk samples (timing not stated) from 44 women obtained at 2 weeks postpartum found detectable acyclovir in 35 samples, with a median concentration of 2.6 mg/L (range 0.15 to 10.15 mg/L) Three of the 9 women with undetectable milk acyclovir levels had missed one or more doses of valacyclovir in the previous 2 days.[3]

Infant Levels. The urine of 5 infants whose mothers were taking valacyclovir 500 mg every 12 hours orally was collected. Valacyclovir was not detected in any of the infant's urine. The median infant urine acyclovir concentration on day 5 of therapy was 0.74 mg/L.[2]


Effects in Breastfed Infants:
In a study of pregnant women with concurrent HIV and Herpes simplex infections, mothers received zidovudine 300 mg daily from week of pregnancy until 12 months postpartum and nevirapine at delivery. Half of the women (n = 74) also received valacyclovir 500 mg orally twice daily from 34 weeks gestation until 12 months postpartum. At 6 weeks postpartum, all infants who received acyclovir in breastmilk had normal serum creatinine (<0.83 mg/dL). Their median serum creatinine and alanine aminotransferase (ALT) values, and growth were no different from those of unexposed infants, with the exception of one infant with an ALT level of 70.1 units/L. Infants whose mothers received valacyclovir generally had adverse effects that were similar to the placebo group, except that treated infants had a lower risk of eczema and oral thrush than infants in the placebo arm.[1][3]


Possible Effects on Lactation:
Relevant published information was not found as of the revision date.


Alternate Drugs to Consider:
Acyclovir

[Calluna]

Thanks Little Chicken
Sooo... what does that mean?
Sorry, Im really not functioning today.

How do I know if the benefit to me outweighs the risk to DS? What is the risk?

Eta- oh ok, so it should be fine?

[Little Chicken]

ok, these are the side effects of aciclovir, which is what valaciclovir is converted into. Remeber, your DS will only be getting a fraction of your dose, and probably even less if he is not fully breastfed anymore. But it is your decision to make knowing all the information out there. Again this is from MIMS

Reversible neurological reactions, notably dizziness, confusion states, hallucinations, somnolence and convulsions, have occasionally been reported, usually in patients with renal impairment in whom the dosage was in excess of that recommended or with other predisposing factors.
Short-term administration for genital herpes. Nausea and/or vomiting and headache were the most frequent adverse effects. Less frequent (< 1%) reactions included diarrhoea, dizziness, anorexia, fatigue, oedema, skin rashes, leg pain, inguinal adenopathy, medication taste and sore throat. Occasional changes in hepatic enzymes and changes in haematological parameters were also noted.
Long-term suppressive therapy for genital herpes. Nausea and/or vomiting, headache, diarrhoea, vertigo and arthralgia were the most frequent adverse effects. Less frequent adverse effects included skin rash, insomnia, fatigue, fever, palpitation, sore throat, superficial thrombophlebitis, muscle cramps, pars planitis, menstrual abnormalities, lymphadenopathy, irritability, accelerated hair loss, depression and occasional increases in hepatic enzymes.
Herpes zoster. The most commonly reported adverse effect was gastrointestinal disturbance. Other reports included aching, chest pain, confusion, constipation, diarrhoea, giddiness, hallucinations, headache, insomnia, nausea, rash, shaking, taste disturbance, tremor, vertigo and malaise, vomiting and mental status alteration. Significantly, the overall incidence of side effects reported was the same in patients on placebo.
Advanced symptomatic HIV disease. In patients receiving antiretroviral therapy (mainly oral zidovudine), no significant overall increase in toxicity was associated with the addition of aciclovir. However, moderate increases in anaemia and neutropenia were seen in some studies in patients with advanced HIV disease.
The frequency categories associated with the adverse events below are estimates. For most events, suitable data for estimating incidence were not available. In addition, adverse events may vary in their incidence depending on the indication.
The following convention has been used for the classification of undesirable effects in terms of frequency: very common greater than or equal to 1/10; common greater than or equal to 1/100 and < 1/10; uncommon greater than or equal to 1/1,000 and < 1/100; rare greater than or equal to 1/10,000 and < 1/1,000; very rare < 1/10,000.
Blood and lymphatic system disorders. Very rare: anaemia, leucopenia, thrombocytopenia.
Immune system disorders. Rare: anaphylaxis.
Psychiatric and nervous system disorders. Common: headache, dizziness, confusion, hallucinations, somnolence, convulsions. Very rare: agitation, tremor, ataxia, dysarthria, psychotic symptoms, encephalopathy, coma.
The above events are reversible and usually reported in patients with renal impairment in whom the dosage was in excess of that recommended, or with other predisposing factors.
Vascular disorders. Common: phlebitis.
Respiratory, thoracic and mediastinal disorders. Rare: dyspnoea.
Gastrointestinal disorders. Common: nausea, vomiting, diarrhoea, abdominal pain.
Hepatobiliary disorders. Rare: reversible rises in bilirubin and liver related enzymes. Very rare: hepatitis, jaundice.
Skin and subcutaneous tissue disorders. Common: pruritus, rashes (including photosensitivity). Uncommon: urticaria, accelerated diffuse hair loss.
Accelerated diffuse hair loss has been associated with a wide variety of disease processes and medicines; the relationship of the event to aciclovir therapy is uncertain. Rare: angioedema.
Renal and urinary disorders. Rare: increases in blood urea and creatinine. Very rare: acute renal failure, renal pain. Renal pain may be associated with renal failure.
General disorders and administration site conditions. Common: fatigue, fever.

[Calluna]

Thank you so much for that info! It is exactly what I needed to know.

[AndiE]

Calluna, sorry to hear you have shingles. I haven't read the last few posts but can tell you a close girlfriend of mine has very recently had shingles, was given antibiotics (her shingles were "caught" early) and she BF'd her then-five month old as normal. As far as I know, BFing wasn't raised as an issue - knowing my friend, she wouldn't have ignored any advice where BFing was concerned. But ... I don't know what medicine she took.

Hope you can continue to BF and you feel better soon.

[Eenee]

Eeek don't stop breastfeeding! Ring and find out from ABA or whatever that number is you call if ok to take while breastfeeding or don't take them because take it from someone who has had shingles 10+ times antivirals don't make that much of a difference.

[Calluna]

Em! Firstly, you poor thing! I was thinking once was sucky enough!
I dont intend to stop, dont worry. Lol I'm going to call Rodney Whyte tomorrow and double check, but I fed him tonight anyway. It's way to stressful to even consider making him sleep without it. He's very stubborn it just wont happen and I'm already feeling crappy enough with out his tired destructive behaviour.

[willow5]

Sounds like you can probably just time your doses so that when he feeds the amount he would get will be pretty small anyway I hope you start to feel better soon xx

[willow5]

How's it going? Feeling any better?

[Calluna]

Hi Willow, thanks for asking hun.

The itching and burning is driving me insane.
Nausea, sharp pains, aching everything, very tired, walking to the bathroom is a major effort. I've slept the majority of the last 3 days. Feel pretty bad for neglecting DS. DF has been with him the last 2 days. So not uncared for but Ive not been very available to him.

Had a little more energy today but not much. I havent been able to cook dinner the last few days, tomorrow should be interesting. DF is back at work. :S Im hoping Ill be miraculously healed by morning..

[willow5]

Oh bugger Well if you're no better tomorrow then ABC2, dvds for DS whatever he likes snuggle with him with snacks and drinks on the couch. It's ok to let them be complete TVholics when you need the rest I think. I know how you feel, I've not been an attentive mummy either the last few months with the HG, MIL is doing most of DSs care while DP is at work, but they will be ok in the end.
Rest up Did they give you anything topical to try and ease the itch and burn? Didn't LMS say she used calamine and it helped a bit. You can go insane with that kind of rash

[Calluna]

I have a version of calamine lotion that the pharmacist gave me. It's not helping much. Only for 5 or 10 mins.

Yeah, he watched dvds all day on Sunday while I slept on and off. I think tomorrow will be the same.

You poor thing, great that you're MIL is helping you out though.

[willow5]

Thank you but this is your thread don't worry about me

I wonder if a bath with some of that Pinetarsol(sp) would help? It helped when my little ones(big ones now) had chicken pox. Hope it eases up soon!