Has this mom ever been withdrawn from medication? Most neurologists
favor a gradual withdrawl from anticonvulsants after a patient has been
seizure free for 2 years, and certainly after 5. About 80% of seizure
free patients are able to continue off meds without seizures. Of
course, pregnancy is not a time to try a med withdrawal, but it
certainly sounds like this mom might not be getting state of the art
care. Also, phenobarb is an old drug, with many side effects.
I have had clients breastfeed on many different medications, including
phenobarb, without problems in their infants. Information on particular
drugs is scarce.
From a Medline search:
Treatment of epilepsy in women of reproductive age: pharmacokinetic
considerations.
McAuley JW, Anderson GD.
Clin Pharmacokinet. 2002;41(8):559-79.
The Ohio State University College of Pharmacy, 500 West 12th Avenue,
Columbus, OH 43210, USA. [log in to unmask]
Although epilepsy affects men and women equally, there are many women's
health issues in epilepsy, especially for women of childbearing age.
These issues, which include menstrual cycle influences on seizure
activity (catamenial epilepsy), interactions of contraceptives with
antiepileptic drugs (AEDs), pharmacokinetic changes during pregnancy,
teratogenicity and the safety of breastfeeding, challenge both the woman
with epilepsy and the many healthcare providers involved in her care.
Although the information in the literature on women's issues in epilepsy
has grown steeply in recent years, there are many examples showing that
much work is yet to be done. The purpose of this article is to review
these issues and describe practical considerations for women of
childbearing age with epilepsy. The article addresses the established or
"first-generation" AEDs (phenobarbital, phenytoin, primidone,
carbamazepine, ethosuximide and valproic acid) and the
"second-generation" AEDs (felbamate, gabapentin, lamotrigine,
levetiracetam, oxcarbazepine, tiagabine, topiramate, vigabatrin and
zonisamide). Although a relationship between hormones and seizure
activity is present in many women, good treatment options for catamenial
epilepsy remain elusive. Drug interactions between enzyme-inducing AEDs
and contraceptives are well documented. Higher dosages of oral
contraceptives or a second contraceptive method are suggested if women
use an enzyme-inducing AED. Planned pregnancy and counselling before
conception is crucial. This counselling should include, but is not
limited to, folic acid supplementation, medication adherence, the risk
of teratogenicity and the importance of prenatal care. AED dosage
adjustments may be necessary during pregnancy and should be based on
clinical symptoms, not entirely on serum drug concentrations. Many
groups have turned their attention to women's issues in epilepsy and
have developed clinical practice guidelines. Although the future holds
promise in this area, many questions and the need for progress remain.
Publication Types:
* Journal Article
* Review
* Review, Tutorial
MeSH Terms:
* Abnormalities, Drug-Induced
* Adolescent
* Adult
* Animals
* Anticonvulsants/*adverse effects/*pharmacokinetics/*therapeutic use
* Breast Feeding
* Clinical Trials
* Contraceptive Agents/therapeutic use
* Drug Interactions
* Epilepsy/*drug therapy/metabolism/physiopathology
* Female
* Human
* Pregnancy
* Pregnancy Complications/drug therapy/metabolism/physiopathology
Substances:
* 0 (Anticonvulsants)
* 0 (Contraceptive Agents)
PMID: 12102641 [PubMed - indexed for MEDLINE]
From PubMed
------------------------------------------------------------------------
2
Anticonvulsant use during lactation.
Hägg S, Spigset O.
Drug Saf. 2000 Jun;22(6):425-40.
Division of Clinical Pharmacology, Norrland University Hospital, Umeå,
Sweden. [log in to unmask]
The issue of prescribing anticonvulsant drugs during lactation is
clinically important, but also complex. Data for some drugs are
completely lacking and for other drugs information is only available
from single dose or short term studies or case reports. Moreover,
limited knowledge exists about the practical impact of the drug
concentrations found in breast milk and there are great methodological
problems in the assessment of possible adverse drug reactions in
infants. Nevertheless, based on current knowledge, some recommendations
can be suggested. Treatment with carbamazepine, valproic acid (sodium
valproate) and phenytoin is considered compatible with breastfeeding.
Treatment with ethosuximide or phenobarbital (phenobarbitone)/primidone
should most probably be regarded as potentially unsafe and close
clinical monitoring of the infant is recommended if it is decided to
continue breastfeeding. Occasional or short term treatment with
benzodiazepines could be considered as compatible with breastfeeding,
although maternal diazepam treatment has caused sedation in suckling
infants after short term use. During long term use of benzodiazepines,
infants should be observed for signs of sedation and poor suckling. Only
very limited clinical data are available for the new generation
anticonvulsant drugs and no clearcut recommendations can be made until
further data are present. If it is decided to continue breast feeding
during treatment with these drugs, the infant should be monitored for
possible adverse effects. In general, the drug should be given in the
lowest effective dose, guided by maternal serum or plasma drug
concentration monitoring. If breast feeding is avoided at times of peak
drug levels in milk, the exposure of the infant can be reduced to some
extent. As breast milk has considerable advantages over formula milk,
the benefits of continuing breast feeding should always be taken into
consideration in the risk-benefit analysis.
Publication Types:
* Journal Article
* Review
* Review, Tutorial
MeSH Terms:
* Anticonvulsants/*adverse effects/pharmacokinetics
* Female
* Human
* Infant, Newborn
* Lactation/*physiology
* Milk, Human/metabolism
Substances:
* 0 (Anticonvulsants)
PMID: 10877037 [PubMed - indexed for MEDLINE]
From PubMed
Hope these help.
Catherine Watson Genna, BS, IBCLC NYC
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