Anticonvulsant use during lactation

The issue of prescribing anticonvulsant drugs during lactation is clinicall y important, but also complex. Data for some drugs are completely lacking a nd for other drugs information is only available from single dose or short term studies or case reports. Moreover, limited knowledge exists about the practical impact of the drug concentrations found in boast milk and there a re great methodological problems in the assessment of possible adverse drug reactions in infants. Nevertheless, based on current knowledge, some recom mendations can be suggested. Treatment with carbamazepine, valproic acid (sodium valproate) and phenytoi n is considered compatible with breastfeeding. Treatment with ethosuximide or phenobarbital (phenobarbitone)/primidone should most probably be regarde d as potentially unsafe and close clinical monitoring of the infant is reco mmended if it is decided to continue breastfeeding. Occasional or short ter m treatment with benzodiazepines could be considered as compatible with bre astfeeding, although maternal diazepam treatment has caused sedation in suc kling infants after short term use. During long term use of benzodiazepines , infants should be observed for signs of sedation and poor suckling. Only very limited clinical data are available for the new generation anticonvuls ant drugs and no clearcut recommendations can be made until further data ar e present. If it is decided to continue breast feeding during treatment wit h these drugs, the infant should be monitored for possible adverse effects. In general, the drug should be given in the lowest effective dose, guided b y maternal serum or plasma drug concentration monitoring. If breast feeding is avoided at times of peak drug levels in milk, the exposure of the infan t can be reduced to some extent. As breast milk has considerable advantages over formula milk, the benefits of continuing breast feeding should always be taken into consideration in the risk-benefit analysis.