Multiple Anticonvulsants and Breastfeeding

[cdavenpo]

Please provide advice concerning breastfeeding while taking 3 anticonvulsants?

1) Pregabalin 100mg twice daily
2)Clonazepam 0.5 mg twice daily
3) Lamotrigine 200mg twice daily

[admin-james]

Hi, thanks for your post.

Pregabalin is small in molecular weight and has the right kinetics to enter milk avidly. In addition is well absorbed orally. I would guess milk levels will be modest. So I'd urge some caution in its use in breastfeeding mothers until we know more.

We have quite a few studies on Clonazepam in breastfeeding mothers. Only one, in which the infant was exposed during pregnancy did the infant have some symptoms of excessive periodic breathing and apnea and cyanosis. This was a 36 week baby, which are prone to problems anyway. Other studies at lower doses (1/2 - 1 mg daily) don't show any problems. In a group of 11 mothers receiving 0.25 to 2 mg clonazepam daily, 10 of 11 breastfed infants had no detectable (limit of detection: 5-14 mcg/L) clonazepam or metabolites in their serum. One infant (1.9 weeks old) had a serum concentration of 22 mcg/L. Maternal dose was 0.5 mg daily.

Lamotrigine may also be used during breastfeeding, but the infant should have plasma levels drawn to ensure safety. The relative infant dose varies from 9.2 percent to 18.3 percent of maternal dose. This infant should be monitored for sedation. There has been one report of apnea in a sixteen day old infant whose mother was on 850 mg daily of lamotrigine.

James Abbey, MD
Tom Hale, Ph.D.
Cindy Pride, MSN, CPNP

Please call us at the InfantRisk Center if this has not completely answered your question.*(806)352-2519