Quantitation of drugs of interest in breast milk

Project Leader: Dr Machel Leuschner

Infants are exposed to medications via breast milk in more than half of women taking medications while breastfeeding. Depending on the disposition of the maternal medicines in the breastmilk, adverse drug reactions may occur in the breastfed infant. It is important that key parameters including relative infant dose (RID): infant drug intake via milk (weight- and time-adjusted) expressed as a percentage of the similarly adjusted mother's dose together with the pharmacokinetics and pharmacodynamics are taken into account when assessing adverse reactions in breastfed infants of mothers taking medications.

Breast milk represents the most important resource in promoting early childhood health, and exclusive breastfeeding for infants is encouraged. Mothers of premature babies or who do not produce enough milk often make use of donated breastmilk where possible. Considering the scarcity of donated breastmilk, it would be ideal to accept and distribute milk from as many donors as possible. However, the safety of donated milk for consumption by developing infants sourced from donors undergoing drug therapy needs to be ensured. Our research is focused on developing and validating LC-MS/MS methods to quantify numerous common drugs, especially neuroactive drugs, and their active metabolites in donor breastmilk samples. By doing this, we aim to determine pharmacokinetic parameters to allow modelling to determine whether breastmilk from donors undergoing various drug therapies may be considered safe for premature baby and infant feeding.

Quantification of sulpiride galactagogue in breastmilk by LC-MS/MS

South Africa has a high prevalence of sulpiride prescription for its off-label use as a galactagogue to treat human milk insufficiencies despite the potential negative effects of this drug on developing infants. This study’s first objective was to develop and optimise a new, more efficient extraction procedure to assist in the detection of sulpiride in very low volume donor breast milk samples utilising high performance liquid chromatography techniques (LC-MS/MS).  Theis new micro-extraction procedure completes the methodology such that it can accurately detect sulpiride drug residues in breastmilk samples while requiring minimal sample volumes. This method will be used in a future pharmacokinetic studies where milk sample volume could otherwise be a crucial limiting factor to determine sulpiride exposure in breastfed premature infants.

Quantitation of Tenofovir and metabolites in dried milk spots using LC-MS/MS

Tenofovir (TFV) is widely used as part of a fixed-dose antiretroviral regimen for the treatment and prophylaxis of HIV infection. Our study aims to determine whether tenofovir and its metabolites are detectable in a small sample of breastmilk spotted on a dried Whatman filter paper.

Collaborators: South African Breastmilk Reserve; Dr Sarel Brand (SMU)

Applicable research levels: Basic research at Hons, MSc or PhD level

Minimum skillsets at MSc and PhD levels: Excellent laboratory and analytical skills including SPE, LLE and LC-MS/MS.

Students: Mr. Tiaan Strydom (MSc.); Kaylene Pillay (MSc.); Vacancy for Honours student interested in pursuing an MSc. degree

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