Lamictal and Wellbutrin - Transition from Pregnancy and Breastfeeding

[jessejean]

Hello,
I am currently 8 months pregnant, and on a regimen of 75 mg Lamictal and 10 mg Wellbutrin daily. When I first became pregnant, I was on 150mg Lamictal, and 300 mg Wellbutrin. Out of fear I stopped using these medications immediately when I found out I was pregnant, which quickly proved to be a bad choice. I had to go back on them at the beginning of the 2nd trimester due to depression, but at the lower dose. I have the following questions:
1. Are there withdrawl symptoms I should look for in the infant at birth?
2. Should I continue at these lower doses during breastfeeding (75mf Lamictal/150mg Wellbutrin)?
3. A midwife suggested to me that since Lamictal has a higher concentration in breast milk, and Wellbutrin a lower concentration, I should try to go to just the Wellbutrin during breatfeeding, and stop the Lamictal. Thoughts?
4. Since the baby is already exposed to the drugs inutero, would it be better for the baby if I continued breastfeeding right from birth so that it does not experience stopping the drug exposure "cold turkey?"

Thank you so much for your time,
Jessica

[cpride]

Dear jessejean,

You should take the lowest effective doses of your medications prescribed by your healthcare provider that adequately control your symptoms in both pregnancy and breastfeeding. You should discuss your symptoms with your healthcare provider so that he/she can monitor your progress. Withdrawal symptoms are not expected after delivery, but your pediatrician will monitor your infant for any health problems. Both lamotrigine (Lamictal) and bupropion (Wellbutrin) are compatible with breastfeeding. Observe your milk supply closely with bupropion as a few mothers have experienced decreased milk supply. Your infant should be monitored for sleep disturbance and restlessness. These side effects are not common as only 0.2% to 2% of your dose enters your 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 infants who are breastfed. Nevertheless, it is advisable to monitor the infant's blood levels closely to ensure safety. You should talk with your pediatrician about when to have lamotrigine levels drawn. Usually the first level is done at about two weeks of age to allow time for the blood level to reflect breastfeed exposure not intrauterine exposure. Observe your infant for sedation. Your lactation consultant at your delivery facility can give you information on getting started with breastfeeding your infant. If you have further questions after delivery, please call us at the InfantRisk Center at 806-352-2519. We are open Monday through Friday, 8 to 5 CDT.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center