Valproic Acid Use During Breastfeeding
Yes, a breastfeeding mother can take valproic acid, as it is considered safe and compatible with breastfeeding based on extensive clinical experience showing minimal infant exposure and no documented adverse effects in nursing infants. 1, 2
Evidence Supporting Safety
Valproic acid is excreted into breast milk in very low concentrations, resulting in minimal infant exposure:
- Infant serum valproate levels range from 0.9% to 2.3% of maternal serum levels, with absolute infant levels of 0.7 to 1.5 mcg/mL—well below the therapeutic range used for epilepsy treatment 3
- In a larger study of 30 mother-infant pairs, 67% of milk samples and 33% of infant serum samples had valproate concentrations below the limit of quantification 4
- Milk-to-maternal serum ratios averaged only 0.03, indicating poor transfer into breast milk 4
- None of the infant serum levels reached the lower limit of the therapeutic range, confirming that breastfeeding exposure is substantially less than in utero exposure 4
Clinical Recommendations
Valproic acid is classified among the traditional anticonvulsants that are generally considered safe for use during breastfeeding:
- The drug has a long track record of safety during lactation, with carbamazepine, valproic acid, and phenytoin specifically recommended as safe options when weighing benefits against risks 1
- Multiple reviews consistently categorize valproic acid as having a good level of safety during lactation due to long-term clinical experience and substantial available data 2
- The FDA label notes that valproate is excreted in human milk and recommends caution, but does not contraindicate breastfeeding 5
Monitoring Considerations
While routine monitoring is not mandatory, observation for potential adverse effects provides an additional safety margin:
- Watch for signs of sedation, poor feeding, or other unusual symptoms in the infant 1
- If any concerning clinical signs develop, measure infant serum valproate concentrations to assess actual exposure 4
- Infant serum drug concentration monitoring is advisable but not compulsory for routine cases 1
Important Context
The safety profile during breastfeeding stands in stark contrast to the significant teratogenic risks during pregnancy:
- The FDA label extensively documents serious pregnancy risks including neural tube defects (1-2% risk), decreased IQ scores, and major congenital malformations (9-11% rate) 5
- These pregnancy concerns do not apply to breastfeeding exposure, where infant drug levels are negligible 4, 3
- No adverse clinical effects have been observed in breastfed infants in published case series 3
The degree of infant exposure through breast milk is substantially lower than in utero exposure, making breastfeeding a much safer scenario than pregnancy for valproic acid use. 4