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I was not on Lamictal during my pregnancy, but my psychiatrist wants me to go back on my regular dose, 100mg/day, now that my baby is nearly 6 months old. I nurse him 5x/day and he gets supplemental formula. My son's pediatrician said she does not recommend being on Lamictal while nursing, but I'm hoping to get a second opinion to show her. The research I have done is that Lamictal is most risky while breastfeeding newborns and if the mother is on high doses. I am hoping to nurse my son through the flu season, which co-incides with when I go back to work (he will be 8 months). At that time, I will either drop down to 1-2 nursing sessions a day or wean him altogether. My husband is siding with the pediatrician, but I am hoping to get confirmation that nursing my son 4-5x/day while he is 6, 7, & 8 months old while I am on 100mg/day of Lamactil is not considerably risky and would move the L3 categorization to something more along the lines of an L2 or even L1. Any insight would be appreciated.
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Dear htdcd,
Lamotrigine (Lamictal) has a high relative infant dose (the amount of mother's dose that transfers into breastmilk) suggesting significant transfer to the infant. Lamotrigine is compatible with breastfeeding as long as the infant is monitored closely. One case of severe apnea has been reported in a 16 day old breastfed infant. In this case, the mother was receiving 850 mg/day, had a plasma level of 14.93 µg/mL. The plasma level of the infant was 4.87 µg/mL. 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. Since you are on a lower dose and have an older infant who has the ability to process medications well, the risk for your infant is lower. It would be recommended to follow plasma levels on your infant to ensure safety. Your pediatrician will decide how often the levels should be monitored. At home, you should monitor your infant for sedation.
Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center -
Infant monitoring
What are some examples of how often infants' levels are checked? Does that require a full blood draw or is it done through other means? Thank you for your help!Comment
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Dear htdcd,
Your local laboratory will decide how the blood should be drawn. Usually the first level is done about one week after starting lamotrigine. Depending on what the first level is, your pediatrician will decide how often to monitor your infant's blood levels. There is no standard of how often the levels should be monitored. If your physician has questions, he/she can call the InfantRisk Center at 806-352-2519. We are open Monday through Friday, 8 to 5, CST.
Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk CenterComment
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