Lamictal and breastfeeding a toddler

[Milka]

Hi,
I'm still breastfeeding my 19month old and we are thinking of trying for a new baby. I have epilepsy and atm take Lamictal 100mg +100mg for it. I had some seizures on my last pregnansy due to the plasenta hormone messing with my drug consecrations. My doctor wants to add my Lamictal to 300-400mg per day before the new pregnansy to prevent seizures. I would like to wait until week 10 so the spinal cord has time to close, but he is intent.
Is it safe to keep breastfeeding my toddler if I start taking higher amounts of the drug? I was thinking of maby keeping only evening, morning and nap feeds and timing my medicine taking times with them.

If I get pregnant my doctor wants to start me with Vimpat at weeks 12. Is that a safe drug to continue nursing?

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[admin]

Milka,

If your toddler is tolerating the Lamictal at 200mg a day, they will probably do ok with 300-400mg a day. Monitor for sedation or irritability, not waking to feed/poor feeding, weight gain and rash. Based on clinical symptoms some infants may require monitoring of liver enzymes or CBC, and Lamictal levels if they become symptomatic.

Vimpat is rated an L3-no data-probably compatible. "Due to its structure, levels in milk may be significant. No data are available on its transfer into human milk, but caution is recommended until we have more data. In pediatric patients it can cause drowsiness, irritability, GI upset and motor instability." (Medications and Mothers' Milk database, Dr Thomas Hale PhD.) Monitor for sedation or irritability, not waking to feed/poor feeding, weight gain, vomiting, diarrhea, tremor. When you are on more than one medication of the same classification, or with similar side effects the risk of the side effects increases. As for your toddler since he or she is older and not consuming as much milk as a newborn it may be ok as long as they are not symptomatic. As for a brand new baby it may be more worrisome. They will be exposed to more in utero than through breast milk and will become somewhat tolerant of the medications, but we worry it may be too much medication and that they may become too sedated and have poor feedings, poor weight gain, or even a slowed breathing rate. Sometimes we recommend half breast milk and half formula to see how new babies tolerate the medications. we suggest you discuss this with your Dr.

Sandra Lovato R.N.
InfantRisk Center
806-352-2519