Is Topiramate safe while breastfeeding?
Here is what NIH LactMed, the U.S. National Library of Medicine's authority on medicines and breastfeeding, reports about Topiramate. This is a summary of that source — not our own verdict.
Effects on the breastfed infant
No adverse effects were observed in 3 infants who were breastfed from birth and observed for at least 24, 27 and 97 days.[ 1 ] The authors subsequently reported 3 additional breastfed infants who also had no adverse effects.[ 5 ] An exclusively breastfed infant whose mother was taking topiramate 300 mg, levetiracetam 2 grams, and valproate 1.8 grams daily during pregnancy and lactation appeared healthy to the investigators throughout the 6- to 8-week study period.[ 7 ] One woman breastfed her infant for 13 months while she was taking topiramate for epilepsy. She took a daily dosage of 150 to 175 mg for the first 6 months, then 200 mg daily. At 1 year of age, the infant was developing normally and both parents stated that no side effects such as tiredness had been observed in the infant.[ 2 ] A woman who took topiramate 300 mg daily throughout pregnancy delivered a normal, healthy infant. She reportedly breastfed her infant exclusively for 8 months at which time no adverse drug effects or neurodevelopmental delay were noted by the infant s pediatrician.[ 8 ] The breastfed infant of a mother who was taking 100 mg of topiramate daily developed watery, foamy stools with 8 to 10 bowel movements daily at 40 days of age. The infant s rate of weight gain also declined. Topiramate was detected in breastmilk at a high concentration. Two weeks later, breastfeeding was discontinued. Within 24 hours, the stool frequency declined to 2 to 3 times daily, more solid and the color and odor normalized.[ 3 ] Topiramate was the probable cause of the diarrhea in the infant. A review of 10 years of reports to the European adverse drug reaction database EudraVigilance found 4 unspecified serious adverse reactions reported in breastfed infants associated with topiramate. Further details of the cases were not reported.[ 9 ] A mother was taking topiramate, hydroxychloroquine, methyl prednisolone and enoxaparin. She reported that her infant of 0.1 months of age who was 25% breastfed experience
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 . Three women were taking oral topiramate daily. One taking 150 mg daily had an average milk level of 2.3 mg/L on day 24 postpartum. A mother taking 200 mg daily had average milk levels of 4.8 mg/L on day 20 postpartum and 4.6 mg/L on day 97 postpartum. The third woman who was taking 200 mg daily had average milk level 610 mcg/L on day 14 postpartum and 1.2 mg/L on day 27 postpartum. The authors estimated that the infants received doses between 0.1 and 0.7 mg/kg daily, which was between 3 and 23% of the mother s weight-adjusted dose.[ 1 ] A woman was taking 175 mg of topiramate daily. On day 12 postpartum, her dose was reduced to 150 mg daily and 4 hours after the dose, her milk topiramate concentration was 3.1 mg/L.[ 2 ] A nursing mother was taking 100 mg of topiramate daily. Topiramate was detected in breastmilk at a concentration of 5.3 mg/L at an unspecified time with respect to the dose. The authors estimated that the infant might have received 35% of the maternal weight-adjusted dosage, although their calculation method is unclear.[ 3 ] Using the milk level of 5.3 mg/L, the infant would have received 56% of the maternal weight-adjusted dosage. Twenty-two women taking topiramate during pregnancy and postpartum had measurements of topiramate in colostrum taken on day 3 or 4 postpartum for routine monitoring. Colostrum topiramate levels averaged 3.5 mg/L. Another 5 mothers had milk samples taken b
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.