Keppra and Trileptal

[hunnod]

I am working with a mother in her third trimester who is currently taking Keppra and dose will be 3000mg/day at delivery. Our concern is that she is also on Trileptal 300mg/twice daily and likely will remain on that for at least 5 weeks postpartum. I have MMM2010 edition and realize they are both L3 with Keppra likely being a little safer but do you have any info on using these medications or other anticonvulsants together while breastfeeding. All of her physicians keep telling her to ask the other one. Any advice would be appreciated. Thank you!
Deanne B. RN, BSN, IBCLC

[admin]

Hunnod:

This is difficult to know for sure, but I would suggest the infant will probably do OK. Primarily because its liver is already highly active at metabolizing these two drugs (levetiracetam and oxycarbazepine). In addition, for the first 4-6 days postpartum, the infant gets very little colostrum or milk, so the dose for at least 4 days will be virtually nil.

In breastfeeding studies of both these drugs, infant plasma levels started to drop after delivery rapidly, suggesting that they are actually quite able to metabolize and excrete both of these drugs and soon after delivery.

One author reports poor feeding in one infant exposed to Keppra, but this infant was not exposed in utero.

I'd suggest the mother continue to breastfeed, and she and her pediatrician closely observe the infant for somnolence or poor feeding.

Tom Hale PH.D.

[hunnod]

Thank you so much for your advice. I will pass this information on to the patient and pediatrician.