Transfer of piperaquine (PQ) into breast milk was examined in 27 Papua New Guinean women given a three-day course of dihydroartemisinin-PQ or sulfadoxine-pyrimethamine-PQ during the second/third trimester. Breast milk was sampled on Days 1, 2, 3-5, 7-11 and 14-17 post-delivery, a median (range) of 70 (6-145) days post-dose. A blood sample was taken at delivery and additional serial samples were available in 9 women who delivered within 42 days of dosing. Milk and plasma PQ was assayed by high performance liquid chromatography. A population-based approach was used to model loge(plasma) and milk concentration-time data. A sigmoid Emax model best described PQ breast milk transfer. The population average milk:plasma PQ ratio was 0.58 with a peak of 2.5 at delivery. The model-derived maximum milk intake (148 mL/kg/day) was similar to the accepted value of 150 mL/kg/day.

 

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