Safety of Lamotrigine, Levetiracetam, and Oxcarbazepine During Breastfeeding
All three antiepileptic drugs—lamotrigine, levetiracetam, and oxcarbazepine—are considered compatible with breastfeeding, though they require infant monitoring for potential adverse effects.
Lamotrigine
Lamotrigine is safe for breastfeeding with a well-documented safety profile and only rare, mild adverse effects in exposed infants. 1, 2
- Lamotrigine is classified among older AEDs with a good level of safety during lactation due to long-term clinical experience and substantial available data 1
- A retrospective study of 20 mother-infant pairs taking lamotrigine (mean dose 161.1 mg/day, range 50-400 mg/day) showed no serious adverse events, with 19 of 20 pairs successfully continuing breastfeeding for at least 1 month postpartum 3
- Observed minor effects included drowsiness, skin rash, and jaundice, but all infants recovered without intervention 3
- Close periodic monitoring of breastfed infants is recommended to detect any potential side effects early, particularly when mothers are taking higher doses 2
Levetiracetam
Levetiracetam is compatible with breastfeeding based on favorable pharmacokinetic properties, though it has a less extensively documented safety profile compared to older AEDs. 1
- The FDA label states that levetiracetam is excreted in breast milk, and decisions should weigh the importance of the drug to the mother against potential risks to the infant 4
- Levetiracetam is classified as compatible with breastfeeding with a less documented but acceptable safety profile compared to traditional anticonvulsants 1
- The relative infant dose and clinical experience suggest low risk, though systematic long-term data remain limited 1, 5
Oxcarbazepine
Oxcarbazepine is compatible with breastfeeding with infant monitoring advisable, as both the drug and its active metabolite (MHD) are present in breast milk. 6, 1, 7
- The FDA label confirms that oxcarbazepine and its active metabolite MHD are present in human milk, though effects on the breastfed infant are unknown 6
- Infant monitoring for potential adverse effects is advisable when mothers take oxcarbazepine during breastfeeding 7
- Oxcarbazepine is considered compatible with breastfeeding but has a less documented safety profile than traditional anticonvulsants like carbamazepine 1
Clinical Monitoring Recommendations
Monitor all breastfed infants for sedation, poor feeding, adequate weight gain, and developmental milestones when mothers are taking any of these three antiepileptic drugs. 1, 7, 2
- Infant serum drug concentration monitoring is advisable but not compulsory 7
- Watch specifically for drowsiness, skin rash, poor suckling, and any signs of toxicity 3
- The benefits of breastfeeding (nutritional, immunological, developmental, social, and economic) should be weighed against theoretical risks to the nursing infant 6, 7
Key Clinical Caveat
The risk of uncontrolled maternal seizures poses greater danger to both mother and infant than the theoretical risks of antiepileptic drug exposure through breast milk. 7, 5