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  • Lamotrigine nursing toddler

    Hi, I was recently diagnosed with a brain cyst that is causing seizures. I was prescribed lamotrigine and having been slowly tapering up from 50mg (25mg/2x day) to 100mg (50mg/ 2x day). My neurologist is willing to let me stay at the lowest dose possible that controls my episodes, knowing that I am still nursing my 13 month old. This doctor also researched the drug and said it seems like one of the safest anticonvulsants to take during nursing, although he suggested long term cognitive effects on the child are not known. Can you inform me about any potential long-term negative effects on my son if I continue to nurse him and take the med? I had planned to let him self-wean, is this advisable, can I keep nursing my toddler safely while on this drug, or should I start the weaning process?
    Last question-are there any special/ specific risks of starting this drug and nursing a toddler who has never been exposed to it? I know a lot of women on the drug take it through pregnancy, so children who are nursed have already been exposed in utero.
    Thank you in advance for your time and expertise.
    Starts
    06-23-2017 01:00 PM
    Last edited by Dcarlo; 06-23-2017, 12:19 PM.

  • #2
    I'm sorry I posted this in 3 different forums...wasn't sure where to place it and really want some feedback.

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    • #3
      Hi!
      in the same situation, any help please?

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      • #4
        Dcarlo,

        Lamictal (lamotrigine) is rated an L2-limited data-probably compatible. The amount that transfers into breast milk is 9.2-18.2% of your dose. "The use of lamotrigine in breastfeeding mothers produces significant plasma 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 postnatally in newborn infants who are breastfed. Nevertheless, it is advisable to monitor the infant's plasma levels closely to ensure safety. In two recent studies by Meador et al, no untoward effects on IQ level were noted in children at age 3 years when exposed to lamotrigine during pregnancy and breastfeeding.[11,12]" (Medications and Mothers' Milk database, Dr Thomas Hale PhD). We think lamotrigine is probably ok to nurse with in low doses as long as your child is not symptomatic, monitor for sedation or irritability, not waking to feed/poor feeding, weight gain and rash. Based on clinical symptoms some infants may require monitoring of liver enzymes or CBC.

        1.##Rambeck B, Kurlemann G, Stodieck SR, May TW, Jurgens U. Concentrations of lamotrigine in a mother on lamotrigine treatment and her newborn child. Eur J Clin Pharmacol 1997; 51(6):481-484.
        2.##Tomson T, Ohman I, Vitols S. Lamotrigine in pregnancy and lactation: a case report. Epilepsia 1997; 38(9):1039-1041.
        3.##Biddlecombe RA. Analysis of breast milk samples for lamotrigine. Internal document BDCR/93/0011. Glaxo-Wellcome 2004.
        4.##Ohman I, Vitols S, Tomson T. Lamotrigine in pregnancy: pharmacokinetics during delivery, in the neonate, and during lactation. Epilepsia 2000; 41(6):709-713.
        5.##Page-Sharp M, Kristensen JH, Hackett LP, Beran RG, Rampono J, Hale TW, Kohan R, Ilett KF. Transfer of Lamotrigine Into Breast Milk. Ann Pharmacother 2006; 40:1470-1471.
        6.##Liporace J, Kao A, D'Abreu A. Concerns regarding lamotrigine and breast-feeding. Epilepsy Behav 2004; 5(1):102-105.
        7.##Newport DJ, Pennell PB, Calamaras MR, et al. Lamotrigine in breast milk and nursing infants: determination of exposure. Pediatrics. 2008;122(1):e223-e231.
        8.##Barr PA, Buettiker VE, Antony JH. Efficacy of lamotrigine in refractory neonatal seizures. Pediatr Neurol. Feb 1999;20(2):161-163.
        9.##Nordmo E, Aronsen L, Wasland K, Smabrekke L, Vorren S. Severe apnea in an infant exposed to lamotrigine in breast milk. Ann Pharmacother. Nov 2009;43(11):1893-1897.
        10.##Fotopoulou C, Kretz R, Bauer S, et al. Prospectively assessed changes in lamotrigine-concentration in women with epilepsy during pregnancy, lactation and the neonatal period. Epilepsy Res. Jul 2009;85(1):60-64.
        11.##Meador KJ, Baker GA, Browning N, Clayton-Smith J, Combs-Cantrell DT, Cohen M, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Pivitera M, Loring DW. Effects of breastfeeding in children of women taking antiepileptic drugs. Neurology. Nov 30 2010; 75(22): 1954-60.
        12.##Meador KJ, Baker GA, Browning N, Clayton-Smith J, Combs-Cantrell DT, Cohen M, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Pivitera M, Loring DW. Cognitive function at 3 years of age after fetal exposure to antiepileptic drugs. N Eng J Med. 2009 Apr 16; 360 (16): 1597-1605.
        13.##Veiby G, Engelsen BA, Gilhus NE. Early child development and exposure to antiepileptic drugs prenatally and through breastfeeding A prospective cohort study on children of women with epilepsy. JAMA Neurol 2013:E1-E8.
        14.##Meador KJ, Baker GA, Browning N et al. Breastfeeding in children of women taking antiepileptic drugs cognitive outcomes at age 6. JAMA Pediatr 2014;168(8):729-36.
        15.##Pennell PB, Peng L, Newport DJ, et al. Lamotrigine in pregnancy: clearance, therapeutic drug monitoring, and seizure frequency. Neurology. May 27 2008;70(22 Pt 2):2130-2136.
        16.##Gentile S. Lamotrigine in pregnancy and lactation. Arch Womens Ment Health. May 2005;8(1):57-58.


        Sandra Lovato R.N.
        InfantRisk Center

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