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I am working with a mother who is currently 20 weeks pregnant and is taking trileptal 600mg BID and lacosamide 200mg daily. She was taken off dilantin when she found out she was pregnant. She would like to breastfeed but is concerned about the medications. Can you give her any information that she would be able to share with her doctor and the baby's doctor about the safety of these medications while breastfeeding? Thank you
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Dear Grapamar,
In a brief and somewhat incomplete study of a pregnant patient who received 300 mg three times daily of Trileptal (Oxcarbazepine), plasma levels were studied in her infant for the first 5 days postpartum while the infant was breastfeeding. Although no breastmilk levels were reported, plasma levels of this drug were essentially the same as the mothers' immediately after delivery, suggesting complete transfer transplacentally of the drug. However, while breastfeeding for the next 5 days, plasma levels in the infant declined significantly. No neonatal side effects were reported by the authors.
Lacosamide, is a new anticonvulsant used as adjunctive therapy in the treatment of partial-onset seizures in patients with epilepsy aged 17 years and older. It does have a small molecular weight of 250, and only 15% of it is protein bound. Therefore, due to its structure and kinetics, levels in milk may be significant. No data are available on its transfer into human milk, but caution is recommended until we have more data.
Since infant has been already exposed in utero, I would suggest breastfeeding with caution. Observe for, sedation, irritability, poor feeding, poor weight gain, vomiting, and diarrhea.
Tassneem Abdel Karim MD
InfantRisk Center
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