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  • Topamax

    I have horrible migraines that I have been unable to control since my medications were discontinued during conception, pregnancy, and breast feeding. My only medication option has been Fioricer. Now, my neuro-opth prescribed topamax (75mg, 2x per day). Prior to getting pregnant, I was able to control my migraines with Topamax. My doctor wants me to stop breast feeding because of the topamax. My daughter is perfectly healthy and 8 months old. She drinks about half breast milk and half formula per day. Do I need to stop breast feeding because of the Topamax?

  • #2

    Topamax (topiramate) is rated an L3-limited data-probably compatible. The amount that transfers into breast milk is 24.68-55.65% of your dose. "Topiramate may be used during breastfeeding with close monitoring. The amount transferred into milk is relatively high. There has also been one case report of an infant with persistent diarrhea. Plasma levels in two infants were 10-20% of maternal plasma levels. Topiramate has become increasingly popular due to its lower adverse effect profile in relation to other treatment options. Due to the fact that the plasma levels found in breastfeeding infants were significantly less than in maternal plasma, the risk of using this product in breastfeeding mothers is probably acceptable." (Medications and Mothers' Milk database, Dr Thomas Hale PhD). Monitor your infant for sedation or irritability, not waking to feed/poor feeding, diarrhea, weight loss.

    Sandra Lovato R.N.
    InfantRisk Center


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