Breastfeeding on Lamotrigine and Clobazam

[CazP]

I have idiopathic generalised epilepsy (IGE) and this has been well controlled with 50mg BD Lamictin and 5mg BD Urbanol (Clobazam) for the past 4 years. Unfortunately I was on this medication throughout my pregnancy. I am so worried that it has harmed my baby, in particular the Urbanol, but my doctor weighed the risks up against the benefits and felt it was better for me to remain on the medication. Can these drugs have had harmful effects on my baby?

Am I able to breastfeed my baby while on these medications?

[admin]

CazP:

Neither of these drugs is horribly teratogenic. There are rumors in the literature that benzodiazepines (such as Clobazam) in general may cause developmental problems, but these are poorly substantiated.

In your case, the risk of seizures during pregnancy, far out-weights the risk of these drugs.

I think your infant will be fine, and I respect the decision your doctor made in continuing them in your case.

Tom Hale Ph.D.

[CazP]

CazP:

Neither of these drugs is horribly teratogenic. There are rumors in the literature that benzodiazepines (such as Clobazam) in general may cause developmental problems, but these are poorly substantiated.

In your case, the risk of seizures during pregnancy, far out-weights the risk of these drugs.

I think your infant will be fine, and I respect the decision your doctor made in continuing them in your case.

Tom Hale Ph.D.

Thank you so much for your reply. What is the opinion on breastfeeding while taking Lamotrigine and Clobazam?

[admin]

CazP:

Lamotrigine does not appear to cause major congenital anomalies and is relatively safer than other seizure medications such as valproic acid. Prevention of seizures during pregnancy is important for the safety of the mother and fetus. Changing seizure medications during pregnancy is not advised due to the risk of increased seizure activity.[8] Folic acid supplementation is recommended prior to and during pregnancy when taking lamotrigine.[12] Lamotrigine should only be used during pregnancy if the benefit to the mother outweighs the risk to the fetus.

Lamotrigine is an anti-seizure medication that is also used to treat bipolar disorder and epilepsy. The drug can cause serious rashes in patients including Stevens-Johnson disorder.[1] Lamotrigine does not appear to cause major congenital anomalies, but one drug registry found a slightly increased risk of cleft lip and palate.[2] Several studies have shown no increased risk of congenital malformations.[3-8] Drug levels must be monitored closely with lamotrigine as pregnancy alters how the drug is metabolized within the body, and drug levels may fall with subsequent development of breakthrough seizures. The drug level should then be decreased after delivery to prevent maternal toxicity.[9, 10] Oral contraceptives can decrease the blood levels of lamotrigine, thereby increasing the risk of break through seizures.[11]

Pregnancy Exposure Registry: To provide information regarding the effects of in utero exposure to lamotrigine, physicians are advised to recommend that pregnant patients taking lamotrigine enroll in North American Antiepileptic Drug (NAAED) Pregnancy Registry. This can be done by calling the toll-free number 1-888-233-2334, and must be done by patients themselves. Information on the registry can also be found at the website [url]http://www.aedpregnancyregistry.org/[/url]. Physicians are also encouraged to register patients in the Lamotrigine Pregnancy Registry; enrollment in this registry must be done prior to any prenatal diagnostic tests and before fetal outcome is known. Physicians can obtain information by calling the Lamotrigine Pregnancy Registry at 1-800-336-2176 (toll-free).

Labor and Delivery The effect of lamotrigine on labor and delivery in humans is unknown.