Drugs in Lactation Guidance

UK Drugs in Lactation Advisory Service

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Anticonvulsants

Individual maternal and infant situations must be taken into account before any drug is prescribed for the mother.
In general, all drugs should be avoided in premature or low birth weight infants, or in those who have any underlying conditions.
If a drug is prescribed, it should be at the lowest practical dose and for the shortest time.

Drugs	Suitability for use in lactation	Comments
Many anticonvulsants, although well established in clinical practice, have been associated with possible adverse effects in nursing infants. Maternal treatment with continued breast feeding will depend on a risk assessment of the balance between the need to treat the mother, the potential drug toxicity and the benefits of breast feeding. Potential toxicity may be enhanced in premature infants, in whom breastfeeding in anticonvulsant-treated mothers is contraindicated. Use of multiple anticonvulsants cannot be routinely recommended due to lack of data or clinical experience in breast-fed infants.
Phenytoin	?	Possible associated case of methaemoglobinaemia. Prefer alternative anticonvulsants.
Phenobarbitone	No	Long half life. Adverse effects, including sedation, poor feeding and possible death have been reported.
Primidone	No	Metabolised to 2 active metabolites, including phenobarbitone. Adverse effects reported. Use safer alternative
Sodium valproate	Yes	Single case of petechial rash. Monitor infant for signs of rash.
Carbamazepine	Yes	Reversible adverse effects reported including hepatic dysfunction and poor suckling. If used, monitor infant for adverse effects.
Oxcarbazepine	?	Potentially less sedative and toxic than carbamazepine. However, very limited human data.
Clonazepam	No	Single case report of apnoea in breast-fed infant associated with maternal use. Avoid unless essential. Short-term use may be acceptable but monitor infant closely.
Gabapentin, Tiagabine, Topiramate, Vigabatrin	No	No human data. Use alternative anticonvulsants with established low risk if possible.
Lamotrigine	?	No reports of adverse effects. Significant amount in milk. Monitor infant for adverse effects, especially rash. Blood level monitoring in infant may be necessary if exposure prolonged.

Drugs classified with '?' should be used with caution and only after an assessment of benefit to the mother versus risk, real or potential, to the infant. These drugs either have insufficient clinical data on their use in lactation to regard as absolutely safe or they have had minor, reversible side effects reported in a breast-fed infant.