~~~~~~~~~~
According to http://www.perinatology.com/exposures/druglist2.htm
Lamotrigine (Lamictal)
Anticonvulsant
CATEGORY:C
Crosses placenta.
BREAST FEEDING: Excreted into breast milk in considerable amounts.
Contraindicated [1]
NEONATAL SIDE EFFECTS: None reported.
1.Ohman I, Vitols S, Tomson T. Lamotrigine in pregnancy: pharmacokinetics
during delivery, in the neonate, and during lactation. Epilepsia. 2000 Jun
41(6):709-13. MEDLINE
Lamotrigine in pregnancy: pharmacokinetics during delivery, in the neonate,
and during lactation.
Ohman I, Vitols S, Tomson T.
Departments of Clinical Pharmacology and *Clinical Neuroscience, Section of
Neurology, Karolinska Institute at Karolinska Hospital, Stockholm, Sweden.
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PURPOSE: To investigate the pharmacokinetics of lamotrigine (LTG) during
delivery, during the neonatal period, and lactation. METHODS:
High-performance liquid chromatography was used to determine plasma and milk
levels of LTG in nine pregnant women with epilepsy treated with LTG, and
plasma levels in their 10 infants. Samples were obtained at delivery, the
first 3 days postpartum, and at breast-feeding 2-3 weeks after delivery.
RESULTS: At delivery, maternal plasma LTG concentrations were similar to
those from the umbilical cord, indicating extensive placental transfer of
LTG. There was a slow decline in the LTG plasma concentration in the newborn
At 72 h postpartum, median LTG plasma levels in the infants were 75% of the
cord plasma levels (range, 50-100%). The median milk/maternal plasma
concentration ratio was 0.61 (range, 0.47-0.77) 2-3 weeks after delivery,
and the nursed infants maintained LTG plasma concentrations of approximately
30% (median, range 23-50%) of the mother's plasma levels. Maternal plasma
LTG concentrations increased significantly during the first 2 weeks after
parturition, the median increase in plasma concentration/dose ratio being
170%. CONCLUSIONS: Our data demonstrate a marked change in maternal LTG
kinetics after delivery, possibly reflecting a normalization of an induced
metabolism of LTG during pregnancy. LTG is excreted in considerable amounts
in breast milk (the dose to the infant can be estimated to >/=0.2-1
mg/kg/day 2-3 weeks postpartum), which in combination with a slow
elimination in the infants, may result in LTG plasma concentrations
comparable to what is reported during active LTG therapy. No adverse effects
were observed in the infants, however.
~~~~~
According to http://www.rxlist.com/cgi/generic/lamotrigine_cp.htm#CP
Absorption
Lamotrigine is rapidly and completely absorbed after oral administration
with negligible first-pass metabolism (absolute bioavailability is 98%). The
bioavailability is not affected by food. Peak plasma concentrations occur
anywhere from 1.4 to 4.8 hours following drug administration.
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