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Anticonvulsants and Breast Feeding

A Critical Review

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Abstract

Progress in the diagnosis and management of seizure disorders and the availability of effective anticonvulsive medications has enabled increasing numbers of epileptic women of child-bearing age to raise families. Breast feeding, which these women may wish to choose, provides health, nutritional, immunological, developmental, social, economic and environmental benefits.

The traditional anticonvulsants, such as phenytoin, carbamazepine and valproic acid (valproate sodium), are generally considered safe for use during breast feeding; however, observation for adverse effects is recommended. The use of phenobarbital while breast feeding is controversial because of its slow elimination by the nursing infant.

The newer anticonvulsants, such as clobazam, felbamate, gabapentin, lamotrigine, oxcarbazepine, tiagabine, topiramate, and vigabatrin, are used mainly as adjunctive therapy. Data on the use of these drugs in pregnancy and lactation, and regarding long term effects on cognition and behaviour, are sparse.

Weighing the benefits of breast feeding against the potential risk to the nursing infant, breast feeding is considered to be safe when the mother is taking carbamazepine, valproic acid or phenytoin. Infant monitoring for potential adverse effects is advisable when the mother is taking phenobarbital, clobazam, gabapentin, lamotrigine, oxcarbazepine or vigabatrin. Monitoring of infant serum drug concentrations is advisable but not compulsory. The use of felbamate, tiagabine and topiramate during breast feeding should await further study.

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Acknowledgements

Supported by the Medical Research Council of Canada. Dr Ito is a recipient of a career award in Health Sciences.

Although Dr Bar-Oz is now affiliated to the Hadassah Medical Center, Jerusalem, at the time he wrote the paper he was a member of the Motherisk Program at the Hospital for Sick Children, University of Toronto, Canada.

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Authors and Affiliations

  1. The Department of Neonatology, Hadassah Medical Center, Jerusalem, Israel

    Benjamin Bar-Oz

  2. The Motherisk Program, Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

    Benjamin Bar-Oz, Irena Nulman,  Gideon Koren & Shinya Ito

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  1. Benjamin Bar-Oz
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  2. Irena Nulman
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  3. Gideon Koren
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  4. Shinya Ito
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Correspondence to Gideon Koren.

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Bar-Oz, B., Nulman, I., Koren, G. et al. Anticonvulsants and Breast Feeding. Pediatr-Drugs 2, 113–126 (2000). https://doi.org/10.2165/00148581-200002020-00004

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