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

Topiramate

February 15, 2016 (Very Low Risk)

Anticonvulsant used for treatment of epilepsy and migraine prophylaxis.

It is moderately excreted into breast milk with the infant receiving just over 10% of the maternal weight-adjusted dose.

Neither clinical nor psychomotor developmental effects have been observed in infants whose mothers were treated. Only a possibly related case of gastroenteritis that resolved after discontinuation of mother’s medication.
Plasma levels of infants whose mothers were treated with topiramate have shown to be undetectable or pretty below (<1 mg / L) the recommended therapeutic level (5-20 mg / L).

Check up the occurrence of diarrhea, irritability and lethargy in infants

Alternatives

We do not have alternatives for Topiramate since it is relatively safe.

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.

Writings

  • τοπιραμάτη (Greek)
  • توبيرامات (Arabic)
  • Топирамат (Cyrillic)
  • 托吡酯 (Chinese)
  • トピラマート (Japanese)
  • C12H21NO8S (Molecular formula)

Drug trade names

References

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  2. Grover S, Avasthi A. Mood stabilizers in pregnancy and lactation. Indian J Psychiatry. 2015Abstract Full text (link to original source) Full text (in our servers)
  3. Davanzo R, Bua J, Paloni G, Facchina G. Breastfeeding and migraine drugs. Eur J Clin Pharmacol. 2014Abstract
  4. Westergren T, Hjelmeland K, Kristoffersen B, Johannessen SI, Kalikstad B. Probable topiramate-induced diarrhea in a 2-month-old breast-fed child - A case report. Epilepsy Behav Case Rep. 2014Abstract Full text (link to original source) Full text (in our servers)
  5. Reimers A. New antiepileptic drugs and women. Seizure. 2014Abstract Full text (link to original source) Full text (in our servers)
  6. Davanzo R, Dal Bo S, Bua J, Copertino M, Zanelli E, Matarazzo L. Antiepileptic drugs and breastfeeding. Ital J Pediatr. 2013Abstract Full text (link to original source) Full text (in our servers)
  7. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. 2013Abstract
  8. Rapcencu AE, Lindhout D, Bulk S. Frequently asked questions on epilepsy, pregnancy and lactation: a EURAP-NL report. Seizure. 2012Abstract Full text (link to original source) Full text (in our servers)
  9. Pringsheim T, Davenport W, Mackie G, Worthington I, Aubé M, Christie SN, Gladstone J, Becker WJ; Canadian Headache Society Prophylactic Guidelines Development Group. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2012Abstract Full text (in our servers)
  10. Gentile S. Topiramate in pregnancy and breastfeeding. Clin Drug Investig. 2009Abstract
  11. Harden CL, Pennell PB, Koppel BS, Hovinga CA, Gidal B, Meador KJ, Hopp J, Ting TY, Hauser WA, Thurman D, Kaplan PW, Robinson JN, French JA, Wiebe S, Wilner AN, Vazquez B, Holmes L, Krumholz A, Finnell R, Shafer PO, Le Guen C; American Academy of Neurology; et al. Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): vitamin K, folic acid, blood levels, and breastfeeding: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of... Neurology. 2009Abstract Full text (link to original source) Full text (in our servers)
  12. Pack AM. Therapy insight: clinical management of pregnant women with epilepsy. Nat Clin Pract Neurol. 2006Abstract
  13. Tomson T. Gender aspects of pharmacokinetics of new and old AEDs: pregnancy and breast-feeding. Ther Drug Monit. 2005Abstract
  14. Johannessen SI, Helde G, Brodtkorb E. Levetiracetam concentrations in serum and in breast milk at birth and during lactation. Epilepsia. 2005Abstract Full text (link to original source) Full text (in our servers)
  15. Crawford P. Best practice guidelines for the management of women with epilepsy. Epilepsia. 2005Abstract Full text (link to original source) Full text (in our servers)
  16. Rubin ET, Lee A, Ito S. When breastfeeding mothers need CNS-acting drugs. Can J Clin Pharmacol. 2004Abstract
  17. Pennell PB. Antiepileptic drug pharmacokinetics during pregnancy and lactation. Neurology. 2003Abstract
  18. Ohman I, Vitols S, Luef G, Söderfeldt B, Tomson T. Topiramate kinetics during delivery, lactation, and in the neonate: preliminary observations. Epilepsia. 2002Abstract Full text (link to original source) Full text (in our servers)
  19. Bar-Oz B, Nulman I, Koren G, Ito S. Anticonvulsants and breast feeding: a critical review. Paediatr Drugs. 2000Abstract