Reviewing multiple medications prior to conception. [Wellbutrin, Lamictal, Topamax]

[bbrumbel]

I plan on trying for my first child soon and I'm reviewing all of my medications before I start. I take three to manage moderate-to-severe anxiety and depression, though two out of the three are classified as anticonvulsants.

• 300mg Bupropion (Wellbutrin)
• 150mg Lamotrigine (Lamictal)
• 50mg Topiramate (Topamax)

What are some of the risks of being on these medications while pregnant and then into breastfeeding?

I've had to stop the Topiramate for an unrelated reason previously, so while not preferred I know I can discontinue it without too much issue. Discontinuing the other two would significantly impact my day-to-day functioning. I have an appointment with my physiatrist later this month and will also address the topic there.

Thank you for your time.

[kaytlin]

Hi bbrumbel,

We commonly see bupropion and lamotrigine used safely in pregnancy and lactation. However, topiramate is generally not considered safe in pregnancy due to increased birth defects (mostly cleft lip or cleft palate). Your psychiatrist will be a great place to have a personalized conversation about your choices. If you are recommended any other medications, feel free to check back.

Best,
Kaytlin Krutsch, PharmD

[admin]

Good morning!

Unfortunately, these evaluations (especially for topiramate) are not black and white. Each mother-infant pair has different considerations that could lead to different results. Topiramate is not used frequently during pregnancy, but it could be necessary in some situations for mom's health. Therefore, a conversation with your medical team would be needed to come to the right solution for you.

Topiramate is typically used in combination with other medications, making it difficult to tell which effects belong to which drug. However, there is some data.

[url]https://pubmed.ncbi.nlm.nih.gov/22730257/[/url]
[url]https://pubmed.ncbi.nlm.nih.gov/22659273/[/url]

Kaytlin Krutsch, PharmD