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[Use of antiepileptic drugs during breastfeeding : What do we tell the mother?]
Nervenarzt 2018; 89(8):913-921N

Abstract

BACKGROUND

Knowledge about the passage of various antiepileptic drugs into breast milk and its consequences for the infant is limited. Faced with this uncertainty, breastfeeding is often discouraged for these patients. The aim of this study was to comprehensively review the available data regarding antiepileptic drugs during breastfeeding, to compare these data with information provided by the summary of product characteristics (SmPCs), and to provide recommendations for the use of these drugs in breastfeeding women.

MATERIAL AND METHODS

We performed a systematic literature review on breastfeeding data for 23 antiepileptic drugs. A breastfeeding compatibility score was developed and validated. The estimated score based on the literature review was compared with the estimated score based on recommendations provided by the SmPCs.

RESULTS

We identified 75 articles containing exposure and safety data for 15 antiepileptic agents during breastfeeding. The comparison between the score values based on the literature review and on the SmPCs revealed a very low degree of concordance (weighted kappa: 0.08).

CONCLUSION

Phenobarbital, primidone, carbamazepine, valproate and levetiracetam are probably compatible with breastfeeding. Treatment with phenytoin, ethosuximide, clonazepam, oxcarbazepine, vigabatrin, topiramate, gabapentin, pregabalin, lamotrigine and zonisamide can be authorized during breastfeeding, provided breastfed infants are carefully monitored for side effects. Since data on the use of mesuximide, clobazam, rufinamide, felbamate, lacosamide, sultiame, perampanel and retigabine are insufficient to adequately assess the risk for breastfed infants, use in breastfeeding women is in principle not recommended and should be carefully evaluated on a case by case basis. In practice, a risk-benefit analysis should be performed for each mother under antiepileptic treatment wishing to breastfeed her child, so that individual risk factors can adequately be taken into account when counseling the patient.

Authors+Show Affiliations

Faculté de biologie et de médecine, Ecole de médecine, Université de Lausanne, Lausanne, Schweiz.Département des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne, Lausanne, Schweiz.Swiss Teratogen Information Service, Service de pharmacologie clinique, Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne, Lausanne, Schweiz.Swiss Teratogen Information Service, Service de pharmacologie clinique, Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne, Lausanne, Schweiz. ursula.winterfeld@chuv.ch.

Pub Type(s)

Journal Article
Systematic Review

Language

ger

PubMed ID

29487964

Citation

Crettenand, M, et al. "[Use of Antiepileptic Drugs During Breastfeeding : what Do We Tell the Mother?]." Der Nervenarzt, vol. 89, no. 8, 2018, pp. 913-921.
Crettenand M, Rossetti AO, Buclin T, et al. [Use of antiepileptic drugs during breastfeeding : What do we tell the mother?]. Nervenarzt. 2018;89(8):913-921.
Crettenand, M., Rossetti, A. O., Buclin, T., & Winterfeld, U. (2018). [Use of antiepileptic drugs during breastfeeding : What do we tell the mother?]. Der Nervenarzt, 89(8), pp. 913-921. doi:10.1007/s00115-018-0496-2.
Crettenand M, et al. [Use of Antiepileptic Drugs During Breastfeeding : what Do We Tell the Mother?]. Nervenarzt. 2018;89(8):913-921. PubMed PMID: 29487964.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Use of antiepileptic drugs during breastfeeding : What do we tell the mother?] AU - Crettenand,M, AU - Rossetti,A O, AU - Buclin,T, AU - Winterfeld,U, PY - 2018/3/1/pubmed PY - 2018/3/1/medline PY - 2018/3/1/entrez KW - Antiepileptic drugs KW - Breastfeeding KW - Breastmilk KW - Epilepsy KW - Summary of product characteristics SP - 913 EP - 921 JF - Der Nervenarzt JO - Nervenarzt VL - 89 IS - 8 N2 - BACKGROUND: Knowledge about the passage of various antiepileptic drugs into breast milk and its consequences for the infant is limited. Faced with this uncertainty, breastfeeding is often discouraged for these patients. The aim of this study was to comprehensively review the available data regarding antiepileptic drugs during breastfeeding, to compare these data with information provided by the summary of product characteristics (SmPCs), and to provide recommendations for the use of these drugs in breastfeeding women. MATERIAL AND METHODS: We performed a systematic literature review on breastfeeding data for 23 antiepileptic drugs. A breastfeeding compatibility score was developed and validated. The estimated score based on the literature review was compared with the estimated score based on recommendations provided by the SmPCs. RESULTS: We identified 75 articles containing exposure and safety data for 15 antiepileptic agents during breastfeeding. The comparison between the score values based on the literature review and on the SmPCs revealed a very low degree of concordance (weighted kappa: 0.08). CONCLUSION: Phenobarbital, primidone, carbamazepine, valproate and levetiracetam are probably compatible with breastfeeding. Treatment with phenytoin, ethosuximide, clonazepam, oxcarbazepine, vigabatrin, topiramate, gabapentin, pregabalin, lamotrigine and zonisamide can be authorized during breastfeeding, provided breastfed infants are carefully monitored for side effects. Since data on the use of mesuximide, clobazam, rufinamide, felbamate, lacosamide, sultiame, perampanel and retigabine are insufficient to adequately assess the risk for breastfed infants, use in breastfeeding women is in principle not recommended and should be carefully evaluated on a case by case basis. In practice, a risk-benefit analysis should be performed for each mother under antiepileptic treatment wishing to breastfeed her child, so that individual risk factors can adequately be taken into account when counseling the patient. SN - 1433-0407 UR - https://www.unboundmedicine.com/medline/citation/29487964/[Use_of_antiepileptic_drugs_during_breastfeeding_:_What_do_we_tell_the_mother] L2 - https://dx.doi.org/10.1007/s00115-018-0496-2 DB - PRIME DP - Unbound Medicine ER -