Is Lacosamide compatible with breastfeeding? Do we have alternatives for Lacosamide?

Lacosamide

July 23, 2018 (Low Risk)

Antiepileptic indicated in partial onset epileptic seizures (EMA2107, FDA 2014).
Out-of-label is used in neuropathic pain, fibromyalgia, osteoarthritis and migraine prophylaxis (Alcántara 2016, Moulin 2014, Gómez 2014), although with disputed evidence of its effectiveness (Wiffen 2013, McCleane 2013).
Oral administration twice a day.

Their pharmacokinetic data (low molecular weight, low protein binding, high pKa) explain the passage to breast milk found in an amount that could be significant, with a very high relative dose, around 19% (Zárubová 2016).

However, other authors have found minimal excretion in the milk of a mother taking lacosamide and levetiracepam throughout pregnancy and at the beginning of lactation, with a relative dose of 1.8%. The mother stopped breastfeeding at 15 days due to somnolence and insufficient feeding of the infant, premature of 36 weeks, although the plasma levels in the infant were very low. At 7 months he had good psychomotor development (Ylikotila 2015).

No problems of somatic or psychomotor development were observed at 18, 24 and 36 months of age in three infants whose mothers took Lacosamide at doses of 300 and 400 mg / day in mono or polytherapy for 7, 8 and 9 months. Levels were not measured in milk or in infants (Lattanzi 2017).

Until more published data on this drug in relation to breastfeeding are known, safer known alternatives may be preferable, especially during the neonatal period and in case of prematurity.

Given the strength of the evidence that exists on the benefits of breastfeeding for the development of babies and the health of mothers, it is advisable to evaluate the risk-benefit of this medication, advising individually the mothers who wish to continue breastfeeding ( Crettenand 2018).

Alternatives

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • Erlosamide
  • Harkoseride

Writings

  • لاكوزاميد (Arabic)
  • Эрльозамид (Cyrillic)
  • 拉考沙胺 (Chinese)
  • ラコサミド (Japanese)
  • C13 H18 N2 O3 (Molecular formula)
  • (2R)-2-(Acetylamino)-N-benzyl-3-methoxypropanamide (Chemical name)
  • ADD-234037; SPM-927 (Experimental code/s)
  • N03AX18 (ATC Code/s)

Drug trade names

References

  1. Crettenand M, Rossetti AO, Buclin T, Winterfeld U. [Use of antiepileptic drugs during breastfeeding : What do we tell the mother?] Nervenarzt. 2018Abstract
  2. Lattanzi S, Cagnetti C, Foschi N, Provinciali L, Silvestrini M. Lacosamide during pregnancy and breastfeeding. Neurol Neurochir Pol. 2017Abstract
  3. EMA-UCB. Lacosamida (Vimpat). Ficha técnica. 2017 Full text (in our servers)
  4. EMA-UCB. Lacosamide (Vimpat). Drug Summary. 2017 Full text (in our servers)
  5. Alcántara-Montero A, Sánchez-Carnerero CI. [Lacosamide and neuropathic pain, a review]. Rev Neurol. 2016Abstract
  6. Zárubová J, Kremláckova V, Borecká K, Marusic P. Plasma and breast milk levels of lacosamide before, during and post pregnancy. 12th European Congress on Epileptology. Poster 193. Epilepsia. 2016 Full text (link to original source) Full text (in our servers)
  7. Ylikotila P, Ketola RA, Timonen S, Malm H, Ruuskanen JO. Early pregnancy cerebral venous thrombosis and status epilepticus treated with levetiracetam and lacosamide throughout pregnancy. Reprod Toxicol. 2015Abstract
  8. Gómez-Argüelles JM, Bermejo PE, Lara M, Almajano J, Aragón E, García del Carrizo F, Blanco MV, Valenzuela-Rojas FJ, Colás J, Sánchez-Del Valle O, Ceballos MÁ, Toribio-Díaz ME, Latorre-González G, Costa-Frossard L, Morin-Martin Mdel M. [Effectiveness of lacosamide in the treatment of refractory neuropathic pain: an open observational trial]. Rev Neurol. 2014Abstract
  9. Moulin D, Boulanger A, Clark AJ, Clarke H, Dao T, Finley GA, Furlan A, Gilron I, Gordon A, Morley-Forster PK, Sessle BJ, Squire P, Stinson J, Taenzer P, Velly A, Ware MA, Weinberg EL, Williamson OD; Canadian Pain Society.. Pharmacological management of chronic neuropathic pain: revised consensus statement from the Canadian Pain Society. Pain Res Manag. 2014Abstract
  10. FDA. Lacosamide. Drug Summary. 2014 Full text (in our servers)
  11. Wiffen PJ, Derry S, Moore RA, Aldington D, Cole P, Rice AS, Lunn MP, Hamunen K, Haanpaa M, Kalso EA. Antiepileptic drugs for neuropathic pain and fibromyalgia - an overview of Cochrane reviews. Cochrane Database Syst Rev. 2013Abstract
  12. McCleane G. Lacosamide for pain. Expert Opin Investig Drugs. 2010Abstract