Antiepileptic use for psychiatric disorders while breastfeeding

Consider the advice on antiepileptic use for psychiatric disorders while breastfeeding in accordance with the Principles of psychotropic use while breastfeeding.

Sodium valproate and carbamazepine are considered safe to use while breastfeeding, although sodium valproate should be avoided in females of childbearing potential. Monitor weight gain and alertness in infants.

Although lamotrigine passes into breastmilk in higher and more variable amounts than carbamazepine and sodium valproate, it has not been associated with problematic adverse effects in infants. Lamotrigine can be taken while breastfeeding with close infant monitoring. If the infant develops a rash, stop breastfeeding until the cause is known—exclude Stevens-Johnsons syndrome (although there have been no case reports of this occurring as a result of breastmilk exposure). If there are serious concerns about lamotrigine impacting an infant, seek expert advice and consider monitoring the infant’s lamotrigine blood concentration.

The effect of pregabalin on an infant while breastfeeding is unknown. Limited data suggest that a small amount of pregabalin passes into breastmilk; consider alternative treatments, especially in neonates and premature infants.

For advice on antiepileptic use in females of childbearing potential, see here.