Abstract
IntroductionThis review provides a synopsis for clinicians on the use of antiepileptic drugs (AEDs) in the breastfeeding mother.MethodsFor each AED, we collected all retrievable data from Hale’s “Medications and Mother Milk” (2012), from the LactMed database (2013) of the National Library of Medicine, and from a MedLine Search of relevant studies in the past 10 years.ResultsOlder AEDs, such as carbamazepine, valproic acid, phenytoin, phenobarbital, primidone are considered to have a good level of safety during lactation, due to the long term clinical experience and the consequent amount of available data from the scientific literature. On the contrary, fewer data are available on the use of new AEDs. Therefore, gabapentin, lamotrigine, oxcarbazepine, vigabatrin, tiagabine, pregabalin, leviracetam and topiramate are compatible with breastfeeding with a less documented safety profile. Ethosuximide, zonisamide and the continue use of clonazepam and diazepam are contraindicated during breastfeeding.ConclusionsAlthough the current available advice on the use of AEDs during breastfeeding, given by different accredited sources, present some contradictions, most AEDs can be considered safe according to our review.
Highlights
This review provides a synopsis for clinicians on the use of antiepileptic drugs (AEDs) in the breastfeeding mother
In mothers suffering from epilepsy or bipolar disorders treated with antiepileptic drugs (AEDs), some concerns on infant health may raise
As the newborn might be indirectly exposed to AEDs via breast milk, pharmacologically treated epilepsy has been and sometimes is still considered a contraindication to breastfeeding, irrespective of which AED is taken by the mother [66]
Summary
This review provides a synopsis for clinicians on the use of antiepileptic drugs (AEDs) in the breastfeeding mother. In mothers suffering from epilepsy or bipolar disorders treated with antiepileptic drugs (AEDs), some concerns on infant health may raise. The decision to encourage breastfeeding in those women should be taken after a careful evaluation of the possible side-effects on the infant caused by the indirect exposure to AEDs via breast milk. Data on the use of AEDs by the nursing woman are mainly represented by single pharmacologic or pharmacokinetic studies and/or by case reports or case series on the side-effects attributed to their presence in breast milk.
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