Lamictal Pregnancy and Breastfeeding

[rmilne702]

I was diagnosed with Bi Polar II prior to pregnancy and was on Lamictal 100mg QD, since I found out I was pregnant my psychiatrist lowered my dose to 50mg QD, and I have been maintaining well. I am now 27 weeks and would like to breastfeed my daughter. I was wondering if this is safe to do and what I would need to do to make this as safe as possible. My doctor doesn't seem to be very knowledgeable on the effects of Lamictal in breastfeeding, however, I have already been on it throughout my pregnancy.

[cpride]

Dear rmilne702,

Lamotrigine (Lamictal) does transfer into breastmilk. The use of lamotrigine in breastfeeding mothers produces significant blood levels in some breastfed infants, although they are apparently not high enough to produce side effects in most cases. Exposure in utero is considerably higher, and levels will probably drop in newborn breastfed infants who are breastfed. Nevertheless, it is advisable to monitor the infant's blood levels closely to ensure safety. The first infant blood level should be done approximately 2 weeks after birth to allow the level to reflect lactation and not pregnancy. Then depending on the level, your pediatrician will recommend when the next level should be done. You should observe for sedation in your infant and if noted, contact your pediatrician. Since you are on a low dose of lamotrigine, the risk for your infant should be reduced. If you have further questions, please contact us at the InfantRisk Center. We are open Monday through Friday, 8 to 5, CDT.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center