Antiepileptic drugs (anticonvulsants) affect the central nervous system (CNS). Especially at higher doses or when multiple CNS-acting drugs are taken in combination, restlessness, weakness in drinking, sedation (drowsiness), and other side effects are possible in the breastfed infant.
Based on a systemic literature review of antiepileptic drugs in breastfeeding, the following assessment of individual agents is provided:
“Probably compatible with breastfeeding.”
- Carbamazepine
- Levetiracetam
- Phenobarbital
- Primidone
- Valproate
“Compatible with reservation if adequate clinical monitoring is provided”:
- Clonazepam
- Ethosuximide
- Gabapentin
- Lamotrigine
- Oxcarbazepine
- Phenytoin
- Pregabalin
- Topiramate
- Vigabatrin
- Zonisamide
“Not recommended due to lack of data”:
- Clobazam
- Felbamate
- Lacosamide
- Mesuximide
- Perampanel
- Retigabine
- Rufinamide
- Sultiam
Manufacturers’ claims in the drug product information do not have to be consistent with the previously listed results of the systemic literature search. They should not be used primarily for decision making because they are often not based on current evidence.
A detailed individual benefit-risk analysis must be performed for each mother who needs to take an antiepileptic drug and wants to breastfeed. Breastfed babies should be carefully monitored. Monotherapy does not appear to be associated with greater risks for severe immediate symptoms in the breastfed baby.
A well-adjusted mother should not be hastily switched. The mother’s psychological state in particular is important for early bonding between mother and baby.
