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Lamictal and pregnancy

Mon, 02/07/2005 - 20:43

Hi everybody

I have juvenile myoclonic epilepsy. I am currently 32 weeks pregnant and take 300mg of lamictal daily and have remained seizure free and well so far. 

I am concerned about the long term side effects of lamictal on my baby if I breast feed. I have recently read a paper "Concerns regarding lamotrigine and breast feeding" by Liporace et al which makes me concerned about the babys ability to metabolise the drug. I now think that I do not wish to breast feed my baby, but I am wondering if my baby goes through withdrawel from lamictal in the early stages of life will he suffer long term side effects from this. I know that breast feeding and especially colostrum has long term benefits but i am cautious due to the lack of information about what process the baby will use to metabolise it and how the build up of the drug in his system might affect his growth and development.

Has anyone else information or experience of bottle feeding or breast feeding a baby after taking lamictal through the pregnancy.

Would be gretaful for any input on how they are and if you think they went through withdrawal or any other side effects.

Thanks

Bugsbunny

Comments

RE: Lamictal and pregnancy

Submitted by zoeph on Thu, 2004-08-05 - 12:00

 

Congrats!  My daughter is 22 months old, and I was on 600mg by the time she was born.  (I just kept soaking the stuff up or something.  What has me grouchy is my new doc, who is an expert at Stanford, says that blood levels with Lamictal are more about compliance than seizure control. NICE.  Seems he wouldn't have cranked me up like that.  I was on 400 before my pregnancy, and 300 now.) 

Anyhow, my daughter is brilliant, perfect, easy going, charming..... the drugs haven't seemed to affect her a bit.  I would LOVE to read that article about breastfeeding.... as you will see why:

After her birth, at children's hospital, they did a couple of blood levels on her.  The strategy was since she had been soaking in it for 9 months the breastmilk wouldn't hurt her.  Thing is?  My breast milk never came in past 4 oz a day.  I was beyond fustrated and slaved away at every trick in the book for 4 weeks.  She got jaundice from starving w/in 2 days and dropped a ton of weight and so was on formula.  The only thing I would do next time is get an "SNS" this wee tube you put next to your nipple with formula.  Thus the baby still associates your breast with food, and it gives your breast time to get with the program. 

She was sleepy those first few days, but I am sure it wasn't withdrawl - it was hunger.  When ever we gave her a little formula to keep her going, she was COMPLETELY perky and alert.

As she was getting no breast milk from me, she went from trace amounts of Lamictal at birth, to none by the time we left the hospital.

As both my grandmother and my mom breastfeed I was blaming the drugs for my total lack of lactaion.  There is a drug they give to some women, but the major side effect of Reglan is.... seizures.  Even in the average population.  The first 6 weeks you will be totally sleep deprived and stressed - and at higher risk for a seizure right? yeah! no way was I going to take that stuff!

We used Enfamil Lipil with Dr. Brown's bottles.

good luck and get a maid service for the first 2 weeks!

 

Congrats!  My daughter is 22 months old, and I was on 600mg by the time she was born.  (I just kept soaking the stuff up or something.  What has me grouchy is my new doc, who is an expert at Stanford, says that blood levels with Lamictal are more about compliance than seizure control. NICE.  Seems he wouldn't have cranked me up like that.  I was on 400 before my pregnancy, and 300 now.) 

Anyhow, my daughter is brilliant, perfect, easy going, charming..... the drugs haven't seemed to affect her a bit.  I would LOVE to read that article about breastfeeding.... as you will see why:

After her birth, at children's hospital, they did a couple of blood levels on her.  The strategy was since she had been soaking in it for 9 months the breastmilk wouldn't hurt her.  Thing is?  My breast milk never came in past 4 oz a day.  I was beyond fustrated and slaved away at every trick in the book for 4 weeks.  She got jaundice from starving w/in 2 days and dropped a ton of weight and so was on formula.  The only thing I would do next time is get an "SNS" this wee tube you put next to your nipple with formula.  Thus the baby still associates your breast with food, and it gives your breast time to get with the program. 

She was sleepy those first few days, but I am sure it wasn't withdrawl - it was hunger.  When ever we gave her a little formula to keep her going, she was COMPLETELY perky and alert.

As she was getting no breast milk from me, she went from trace amounts of Lamictal at birth, to none by the time we left the hospital.

As both my grandmother and my mom breastfeed I was blaming the drugs for my total lack of lactaion.  There is a drug they give to some women, but the major side effect of Reglan is.... seizures.  Even in the average population.  The first 6 weeks you will be totally sleep deprived and stressed - and at higher risk for a seizure right? yeah! no way was I going to take that stuff!

We used Enfamil Lipil with Dr. Brown's bottles.

good luck and get a maid service for the first 2 weeks!

RE: RE: Lamictal and pregnancy

Submitted by bugsbunny on Fri, 2004-08-06 - 07:40

Hi,

Thanks so much for the info. My neurologist decided not to up my levels of lamictal, my blood levels have dropped about 40% so far, but he reckons I could weather the drop when its occurs gradually over time. I finished work when I reached 30 weeks to compensate by getting extra rest and no stress, so all is well so far thank goodness. Its really good to hear that your daughter is well. I think I will bottle feed, although the neurogist says the benefits most probably outweigh the risks, yet he doesn't know the risks of the baby getting lamictal long term. I am relieved to hear your baby did well on bottle feeding, I wonder if the fact that the baby gets plenty milk when bottle feeding helps them get over the withdrawel, you knwo how important a decent diet is for those of us with epilepsy. Anyhow you have put my mind at rest about bottle feeding, thanks. I don't know how to attach the document  to this mail, it is a pdf file. I could send it to an ordinary email address if you wish to give me one or if you know how I can attach the file here let me know. Anyhow the paper is

Concerns regarding lamotrigine and breast feeding by liporace et al, 2004, epilepsy and behaviour journal.

My brother got this copy for me, he works at a university, maybe you know someone who might be able to look it up or else if you wish to send me a email address, I can attach the pdf file to it and you can read it online.

In summary the paper expresses concern about the recommendation that its ok to breastfeed with lamictal. Apparently the process (gluconiration or something like that) by which out bodies break down lamictal is not developed in children until they are much older. The research paper surveyed 10 babies that were breast fed and their blood  plasma lamictal levels increased every day, in other words the scientist suggested that the babies possible were not able to break down the lamictal, hence it was building up in their bodies and could potentially be toxic. You see then there is also the possibility that if they don't break it down by the same process as us and use some other mechanism it may be that they could produce a toxic by product from breaking down the drug. I am sorry if you are confused and I am not explaining this very well, it would be better if you read the paper.  

My problem is I don't trust my neurologist telling me stuff with the words "most probably" in it, a friend who is a pharmacist suggested that breast feeding was a crazy idea especially when there was little or no data available on the long term effects of lamictal on the baby, in other words we know they get the potentially nasty stuff for 9 months but why lengthen the time exposed to the stuff by breast feeding.

So you see really I am against the whole idea of breast feeding although my neuroligist and midwife is pro the idea. You have put my mind at ease about bottle feeding though and also you might be right in that my partner could do the night feeds etc.

Let me know if you have any other thoughts.

Thanks a mil.

 

Hi,

Thanks so much for the info. My neurologist decided not to up my levels of lamictal, my blood levels have dropped about 40% so far, but he reckons I could weather the drop when its occurs gradually over time. I finished work when I reached 30 weeks to compensate by getting extra rest and no stress, so all is well so far thank goodness. Its really good to hear that your daughter is well. I think I will bottle feed, although the neurogist says the benefits most probably outweigh the risks, yet he doesn't know the risks of the baby getting lamictal long term. I am relieved to hear your baby did well on bottle feeding, I wonder if the fact that the baby gets plenty milk when bottle feeding helps them get over the withdrawel, you knwo how important a decent diet is for those of us with epilepsy. Anyhow you have put my mind at rest about bottle feeding, thanks. I don't know how to attach the document  to this mail, it is a pdf file. I could send it to an ordinary email address if you wish to give me one or if you know how I can attach the file here let me know. Anyhow the paper is

Concerns regarding lamotrigine and breast feeding by liporace et al, 2004, epilepsy and behaviour journal.

My brother got this copy for me, he works at a university, maybe you know someone who might be able to look it up or else if you wish to send me a email address, I can attach the pdf file to it and you can read it online.

In summary the paper expresses concern about the recommendation that its ok to breastfeed with lamictal. Apparently the process (gluconiration or something like that) by which out bodies break down lamictal is not developed in children until they are much older. The research paper surveyed 10 babies that were breast fed and their blood  plasma lamictal levels increased every day, in other words the scientist suggested that the babies possible were not able to break down the lamictal, hence it was building up in their bodies and could potentially be toxic. You see then there is also the possibility that if they don't break it down by the same process as us and use some other mechanism it may be that they could produce a toxic by product from breaking down the drug. I am sorry if you are confused and I am not explaining this very well, it would be better if you read the paper.  

My problem is I don't trust my neurologist telling me stuff with the words "most probably" in it, a friend who is a pharmacist suggested that breast feeding was a crazy idea especially when there was little or no data available on the long term effects of lamictal on the baby, in other words we know they get the potentially nasty stuff for 9 months but why lengthen the time exposed to the stuff by breast feeding.

So you see really I am against the whole idea of breast feeding although my neuroligist and midwife is pro the idea. You have put my mind at ease about bottle feeding though and also you might be right in that my partner could do the night feeds etc.

Let me know if you have any other thoughts.

Thanks a mil.

 

RE: RE: RE: Lamictal and pregnancy

Submitted by rhilets on Fri, 2004-08-06 - 10:36

Hi,

I'd just like to say congratulations on the pregnancy!!  I am just 33 weeks so at a very similar stage to you but I take Tegretol which has created some real dilemmas in taking it.  I hadn't had a fit (I have tonic-clonic but very infrequently) for 9 years so I felt, after having had a successful pregnancy with my son who is now 4, that I could safely cut down my dosage but on friday I had a full on seizure which has really shaken me up, of course mainly because of the risk to the baby.  I was rushed to hospital and put on a monitor - baby seems fine and I hope hasn't been adversely affected but it has really highlighted the difficulties with taking AEDs and pregnancy.  I chose to take a minimum dose because of Tegretol's notorious connections with birth defects but in the end I probably put the baby and myself at much more risk. 

As far as breastfeeding goes, I think the benefits of having breast milk far outweigh the risks with the minute amount of Tegretol that gets through but with Lamictal I don't know.

Continue to take it easy and as much as you can, avoid any triggers.  You are doing really well and not much longer now!!  What are you doing about labour, btw, are you concerned about having an attack during labour?  I wasn't until last week, when epilepsy so suddenly and cruelly re-entered my world, now I'm wondering if I might opt for a section instead.

Rhiannon3

 

Hi,

I'd just like to say congratulations on the pregnancy!!  I am just 33 weeks so at a very similar stage to you but I take Tegretol which has created some real dilemmas in taking it.  I hadn't had a fit (I have tonic-clonic but very infrequently) for 9 years so I felt, after having had a successful pregnancy with my son who is now 4, that I could safely cut down my dosage but on friday I had a full on seizure which has really shaken me up, of course mainly because of the risk to the baby.  I was rushed to hospital and put on a monitor - baby seems fine and I hope hasn't been adversely affected but it has really highlighted the difficulties with taking AEDs and pregnancy.  I chose to take a minimum dose because of Tegretol's notorious connections with birth defects but in the end I probably put the baby and myself at much more risk. 

As far as breastfeeding goes, I think the benefits of having breast milk far outweigh the risks with the minute amount of Tegretol that gets through but with Lamictal I don't know.

Continue to take it easy and as much as you can, avoid any triggers.  You are doing really well and not much longer now!!  What are you doing about labour, btw, are you concerned about having an attack during labour?  I wasn't until last week, when epilepsy so suddenly and cruelly re-entered my world, now I'm wondering if I might opt for a section instead.

Rhiannon3

 

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