Is Lacosamide safe while breastfeeding?
Here is what NIH LactMed, the U.S. National Library of Medicine's authority on medicines and breastfeeding, reports about Lacosamide. This is a summary of that source — not our own verdict.
Effects on the breastfed infant
A pregnant woman suffered blood clots in the sinuses and 2 small intracranial hemorrhages followed by status epilepticus at 8 weeks of gestation. She was treated with levetiracetam 1000 mg and lacosamide 100 mg twice daily as well as enoxaparin and labetalol for the rest of her pregnancy and postpartum. Her infant was delivered at 36 weeks gestation and about 50% breastfed for the first days of life. The infant was sleepy and fed poorly, but pauses in breastfeeding did not improve the infant's condition. Breastfeeding was discontinued at 15 days postpartum and the infant gradually improved. The infant showed normal development at 7 months of age.[ 1 ] Lacosamide and levetiracetam were probably the cause of the infant's sedation and poor feeding. One center reported 3 mothers with epilepsy who took lacosamide while breastfeeding their infants. The extent of breastfeeding was not clearly stated, but one woman only partially breastfed her infant. The first mother took levetiracetam 2000 mg daily plus lacosamide 200 mg twice daily and breastfed her infant for 7 months with no infant adverse effects at 24 months of age. The second mother took lacosamide 300 mg daily and partially breastfed her infant for 8 months with normal developmental milestones at 6, 12 and 18 months of age. The third mother took lacosamide 400 mg daily and breastfed for 9 months without any feeding or alertness problems and no cognitive alterations or developmental delays at 36 months of age.[ 9 ] A woman took lacosamide and levetiracetam throughout pregnancy and while exclusively breastfeeding her infant. Despite receiving a relatively high dose in breastmilk, the infant reportedly had achieved developmental milestones and had no health problems at 6 months postpartum.[ 7 ] An infant was exclusively breastfed by a mother taking brivaracetam, lacosamide and perampanel for 6 weeks, then partially breastfed. The infant did not exhibit reduced wakefulness or feeding problems. At one year of age, the m
Effects on milk supply
Relevant published information was not found as of the revision date.
Levels in milk
In published reports of anticonvulsant use during breastfeeding, most women were taking a combination of anticonvulsants. Some other anticonvulsants (e.g., phenytoin, carbamazepine) stimulate the metabolism of other drugs including anticonvulsants, whereas others (e.g., valproic acid) inhibit the metabolism of other drugs. Therefore, the relationship of the maternal dosage to the concentration in breastmilk can be quite variable, making calculation of the weight-adjusted percentage of maternal dosage less meaningful than for other drugs in this database. Maternal Levels. A pregnant woman was treated with levetiracetam 1000 mg and lacosamide 100 mg twice daily as well as enoxaparin and labetalol for the rest of her pregnancy and postpartum. The lacosamide level in milk on day 5 postpartum (exact time unspecified) was 0.4 mg/L. The authors estimated that a fully breastfed infant would receive about 1.8% of the maternal weight-adjusted dosage.[ 1 ] A woman took oral lacosamide 200 mg daily (dosage schedule not stated) throughout pregnancy and postpartum. At 20 days postpartum, breastmilk levels were 3.57 mg/L before the dose, 5.46 mg/L at 2 hours after the dose and 4.24 mg/L at 6 hours after the dose.[ 2 ] An abstract reported that a relative infant dose of 29.9% was found in nursing mother(s) taking lacosamide, who provided 8 milk samples over 24 hours. The authors estimated that a breastfed infant could receive as much as 254% of the pediatric dose, but other details were not supplied.[ 3 ] A mother was taking lacosamide 200 mg twice daily as well as brivaracetam 100 mg twice daily and perampanel 8 mg daily. Her milk lacosamide levels were 21 micromoles/L (5.26 mg/L) on day 5 postpartum 12 hours after the previous dose and 25 micromoles/L (6.26 mg/L) on week 5 postpartum 13 hours after the previous dose.[ 4 ] A postpartum woman was taking lacosamide 50 mg twice daily. Her dose was increased to 100 mg twice daily (3.6 mg/kg daily) and the following day, milk samples w
Alternatives LactMed lists
Source: NIH LactMed (National Library of Medicine).
Educational summary of an authoritative source — not medical advice. Never start, stop, or change a medicine while breastfeeding without confirming with your doctor.