Severe Apnea in an Infant Exposed to Lamotrigine in Breast Milk

Abstract

Infants can be exposed to clinically relevant doses of lamotrigine through breast-feeding. Individual risk/benefit assessment is important, and close monitoring of both mother and child is advisable, especially during the first 3 weeks postpartum.

Lamotrigine Dosing for Pregnant Patients With Bipolar Disorder

“…Milk-to-plasma ratios have been reported in 40 lactating women taking lamotrigine in case reports (9, 28, 30, 31), case series (10, 17, 32–34), and a prospective study (26). On average, the milk-to-plasma ratio is 60% (9, 10, 17, 28), with wide interindividual variation (17, 26).…”

“…Infant plasma concentrations have been obtained in 40 infants whose mothers were taking lamotrigine while breast-feeding (9, 10, 12, 17, 26, 28, 31, 32). All but one had a detectable lamotrigine serum level (32).…”

Neonatal Outcomes of Epileptic Mothers’ Infants in the Tertiary Level Of Neonatal Intensive Care Unit: Results from Single Center

“…Fakat literatür-de, birçok ilacın emzirme sırasında güvenilir olarak kullanılabileceği belirtilmektedir (11,14) . Yalnız gebelikte ve emzirme sırasında lamotrigin kullanan anne bebeklerinde apne, emme bozukluğu, santral sinir sistemi depresyonu ve ciddi cilt reaksiyonları bildirilmiş-tir (15)(16)(17) . Lamotriginin kullanırken emzirmeye ara verilmesi önerilmese de bebeklerin yan etkiler açısın-dan yakın takip edilmesi önerilir.…”

Normocytic Normochromic Anaemia and Asymptomatic Neutropenia in a 40‐Day‐Old Infant Breastfed by an Epileptic Mother Treated With Lamotrigine: Infant's Adverse Drug Reaction

“…Central diabetes insipidus is a frequent manifestation of brain tumours. 2,3 This case shows that simultaneous shortage of many hormones may mask common clinical symptoms of underlying …”

“…2 Breastfed infants may undergo serious adverse effects, as observed in a 16-day-old infant that developed severe apnea following exposure to lamotrigine through breastmilk (maternal dose 850 mg die, infant lamotrigine blood level 4.87 mg/L). 3 Newport et al estimated a mean milk/ plasma ratio of 41.3% (range 33.0-49.6%), with infant plasma concentration corresponding to 18.3% of maternal plasma levels (theoretical infant lamotrigine dose: 0.51 mg/kg/day; relative infant lamotrigine dose: 9.2%). At infant lamotrigine blood levels ranging from 0.6 to 1.8 mg/L, only mild thrombocytosis was observed.…”