In an effort to learn more about this medication myself, I contacted the center for information on medications in pregnancy and lactation at our local children's hospital. I was told that their current recommendation regarding Topomax is to refrain from breastfeeding, because 1) it is a new medication believed to pass into milk quite freely (low molecular weight and protein-bound); and 2) possible neuro-motor side effects on the baby are not known and therefore it's more than just a matter of measuring levels in the milk. Trials on rodents have demonstrated some worrisome side effects on the nursling. 

Their thought was that the mother, if she is on this medication, has probably already tried, without success, other anti-epileptic medications more compatible with breastfeeding (such as Tegretol), so her options are limited, since she probably has no other choice but to take this medication. Whether or not this is the case, she should be given this information and told what the risks may be for her baby, and allowed to decide whether or not she feels comfortable breastfeeding in light of the lack of information currently available on this medication. I agree that too many times, mothers are told not to breastfeed by sometimes over-cautious (or ill informed) health practitioners, but when there is so little to go by, is it really possible to measure the benefits of breastfeeding against unknown risks? Only she can decide whether or not she considers that she would be a "human guinea pig" if she chose to breastfeed. Nevertheless, the decision should be the mother s, not the OB's.

Stephanie Dupras
Breastfeeding Counsellor, Nourri-Source
Montreal, Quebec (Canada)

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