From the Guidelines
Breastfeeding is generally considered acceptable for an epileptic postpartum woman taking phenobarbital, with the mother continuing her prescribed anticonvulsant regimen while breastfeeding, as seizure control remains the priority. According to the evidence-based guidelines for mental, neurological, and substance use disorders, standard breast feeding recommendations remain appropriate for antiepileptic drugs, including phenobarbital 1. The benefits of breastfeeding typically outweigh the risks, as phenobarbital has a long history of use during lactation with relatively few reported adverse effects in infants.
Some key points to consider:
- Phenobarbital does pass into breast milk at moderate levels, with infants receiving approximately 2-5% of the weight-adjusted maternal dose.
- Close monitoring of the infant for excessive sedation, poor feeding, or unusual sleepiness is essential.
- The infant's pediatrician should be informed about the mother's medication and involved in monitoring the baby's development.
- In cases where the mother is on high doses of phenobarbital or if the infant was premature or has liver dysfunction, more careful assessment may be needed, possibly including measurement of the infant's serum drug levels if concerning symptoms develop.
Therefore, the best option for the epileptic postpartum lady on phenobarbital is to feed normally while continuing her prescribed anticonvulsant regimen, with close monitoring of the infant for any potential adverse effects. This approach prioritizes both the mother's seizure control and the benefits of breastfeeding for the infant, as recommended by the guidelines 1.
From the Research
Breastfeeding Options for an Epileptic Postpartum Lady on Phenobarbital
- The best option for an epileptic postpartum lady on phenobarbital who plans to breastfeed is to feed normally while being monitored for any potential side effects in the infant 2, 3.
- Phenobarbital is considered quite safe with a low risk for breastfeeding, and the decision to breastfeed should take into account the dose, serum levels, transmission, and elimination rates in the infant, as well as the conditions of the newborn infant 2.
- The World Health Organisation recommends that breastfeeding should be the norm for all women, even in epileptic mothers taking antiepileptic drugs (AEDs), with careful monitoring for adverse effects in the infant 2.
- Studies have shown that breastfed infants of mothers taking AEDs, including phenobarbital, have low serum levels of the drug and rarely report adverse symptoms 3, 4.
- Healthcare providers should perform a risk-benefit analysis for each mother under antiepileptic treatment wishing to breastfeed, taking into account individual risk factors and monitoring the infant for potential side effects 5.
Key Considerations
- The benefits of breastfeeding for the infant, including nutrition, protection against infectious and immunological disease, and promotion of development and psychological attachment, should be weighed against the potential risks of exposure to AEDs via breastmilk 3.
- The nursing infant's degree of drug exposure can be minimized by breastfeeding when drug concentrations in the milk are low, reducing maternal AED dosage to prepregnancy levels, and administering mixed nutrition 3.
- Phenobarbital, along with other AEDs such as lamotrigine, pregabalin, and levetiracetam, is considered compatible with breastfeeding, but careful monitoring of the infant for side effects is recommended 5, 6.