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Breastfeeding and vimpat and keppra

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  • Breastfeeding and vimpat and keppra

    I have a mom who gave birth today to twin girls at term. She has been on Keppra and Vimpat throughout pregnancy and would like to breastfeed. I consulted Dr. Hale's 2014 book but there was not enough data on Vimpat to tell if there will be issues; it looks like Keppra should be okay with monitoring. Please let me know if anything has changed. Thank you for your time.

  • #2
    Hi, thanks for your post.

    Our assessment of Keppra remains unchanged since the 2014 edition. We agree that it should be OK with monitoring.

    A recent paper on Vimpat (See Cawello below) elaborates on its pharmacokinetic properties. The same factors that make it an excellent medication also make it more likely to appear in the milk in significant quantities. A handful of small studies and case reports (see remaining citations below) by and large characterize Vimpat as "well-tolerated" in infants and young children. Dizziness, nausea, and agitation are the most commonly reported side effects. The long-term neurodevelopmental consequences of incidental exposure to this medication are unknown. It is also unclear what effect a sub-therapeutic quantity of the drug would have on a patient without a seizure disorder.

    It is difficult to make firm recommendations without more robust data. Given that adverse effects of this drug in adults appear to be fully reversible, it is my opinion that the benefits of breastfeeding likely exceed the risks of this drug as we currently understand them. The mother should be advised to watch the child for changes in sleeping and feeding habits. Medication exposure should remain high on the differential if problems arise. A good first step to resolving such problems is diluting the milk 50:50 with hydrolyzed formula.

    I will flag our "lacosamide" entry for internal review so that these new studies can be included.

    Please call us at the InfantRisk Center if this has not completely answered your question.*(806)352-2519

    -James Abbey, MD

    Cawello W, Stockis A, Andreas JO, Dimova S. Advances in epilepsy treatment: lacosamide pharmacokinetic profile. Ann N Y Acad Sci. 2014 Nov;1329:18-32. Epub 2014 Aug 28. Review. PubMed PMID: 25167889.

    Grosso S, Parisi P, Spalice A, Verrotti A, Balestri P. Efficacy and safety of lacosamide in infants and young children with refractory focal epilepsy. Eur J Paediatr Neurol. 2014 Jan;18(1):55-9. Epub 2013 Oct 3. PubMed PMID: 24129195.

    Casas-Fern?ndez C, Mart?nez-Bermejo A, Rufo-Campos M, Smeyers-Dur? P, Herranz-Fern?ndez JL, Ib??ez-Mic? S, Campistol-Plana J, Alarc?n-Mart?nez H, Campos-Castell? J. Efficacy and tolerability of lacosamide in the concomitant treatment of 130 patients under 16 years of age with refractory epilepsy: a prospective, open-label, observational, multicenter study in Spain. Drugs R D. 2012 Dec 1;12(4):187-97. PubMed PMID: 23193979.

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    • #3
      I am 11 weeks pregnant and on keppra 1400 mg a day and I was wondering if anyone has had any birth defects on this medicine or any issues with breastfeeding?

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      • #4
        Libra05, thanks for posting,

        Keppra (levetiracetam) is rated P3-unknown, risk to fetus cannot be ruled out. Human studies linking the use of this product with birth defects are not available. Use only if the benefit to the mother exceeds the potential risk to the fetus. Animal studies and humans experiences shows that levetiracetam can cause fetal growth impairment and malformations. Discontinuation of antiepileptic treatments may result in disease worsening, which can be harmful to the mother and the fetus. In animal studies, levetiracetam produced evidence of developmental toxicity at doses similar to or greater than human therapeutic doses. There are no adequate and well-controlled studies in pregnant women. As with other antiepileptic drugs, physiological changes during pregnancy may affect levetiracetam concentration. There have been reports of decreased levetiracetam concentration during pregnancy. Remember that 1-3% of all pregnancies can result in a birth defect due to chance alone.

        Keppra in breastfeeding is rated L2-safer. The amount transferred to the infant is 3.4-7.8% of moms dose. The infants are exposed to more of the medication in utero than breast milk, and the infants can clear it very quickly. Monitor the infant for sedation or irritability, not waking to feed/poor feeding and weight gain.

        I hope this helps. If you have any other questions please call the InfantRisk Center at 806-352-2519. Thanks,

        Sandra Lovato R.N.
        InfantRisk Center

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