Is Carbamazepine Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Carbamazepine? Is Carbamazepine safe for nursing mother and child? Does Carbamazepine extracts into breast milk? Does Carbamazepine has any long term or short term side effects on infants? Can Carbamazepine influence milk supply or can Carbamazepine decrease milk supply in lactating mothers?

Excreted into breast milk in moderate amount that could arrive to be significant. Most infants reported were not found of suffering clinical issues at short or long term. However, serum levels have reached a low range of therapeutic levels, with isolated cases of somnolence, poor feeding and transient liver dysfunction with associated cholestasis. One case of Deprivation Syndrome has been reported after sudden discontinuation of medication. The American Academy of Pediatrics rates it as usually compatible with Breastfeeding. Eleventh WHO Model List of Essential Drugs 2002: Compatible with breastfeeding.

Breastfeeding during carbamazepine monotherapy does not appear to adversely affect infant growth or development, and breastfed infants had higher IQs and enhanced verbal abilities than nonbreastfed infants at 6 years of age in one study.[1] If carbamazepine is required by the mother, it is not necessarily a reason to discontinue breastfeeding. Carbamazepine has relatively high levels in breastmilk and breastfed infants have serum levels that are measurable, but usually below the anticonvulsant therapeutic range. Most infants have had no adverse reactions, but sedation, poor sucking, withdrawal reactions and 3 cases of hepatic dysfunction have been reported. These have all been complicated because of intrauterine exposure and, in some cases, concurrent drug therapy. Monitor the infant for jaundice, drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of anticonvulsant or psychotropic drugs. One author recommends monitoring infant serum carbamazepine levels, liver enzymes, and a complete blood count during therapy.[2]

No adverse effects were noted by the mothers in 3 breastfed infants during maternal carbamazepine and phenytoin therapy.[4] An epileptic woman taking carbamazepine 1 g and primidone 1 g daily during pregnancy and postpartum breastfed her infant for 5 weeks and noted no difference in activity in the infant before and after nursing.[6] A probable case of drug-induced drowsiness occurred in a newborn whose mother was taking primidone, carbamazepine and phenytoin (dosages not stated). At day 30, breastfeeding was discontinued because of the drowsiness that occurred after each feeding and poor weight gain. The same group of researchers found that 15 partially breastfed infants whose mothers were taking various anticonvulsants, including carbamazepine, gained weight at a slower rate during the first 5 days postpartum than did 75 infants of epileptic mothers who bottle fed or control mothers taking no medications.[17] A 10-week-old breastfed infant whose mother was taking clemastine, phenytoin and carbamazepine was drowsy, refused to feed, was irritable, and had high-pitched crying.[18] These side effects were possibly caused by clemastine in breastmilk, but the other drugs could also have contributed. Poor sucking, vomiting and lack of weight gain was reported in a partially breastfed 4-week-old whose mother was taking carbamazepine monotherapy in a dose of 11 mg/kg daily.[7] Weak sucking occurred in 1 of 15 breastfed infants whose mothers were on carbamazepine monotherapy, but a causal relationship could not be confirmed.[8] A breastfed infant whose mother was taking primidone 375 mg, phenobarbital 90 mg, and carbamazepine 800 mg daily did well despite a saliva phenobarbital level of 3.4 mg/L. At 7 months of age, after the mother abruptly stop nursing, the infant had a number of "startle reactions" and infantile seizures occurred which were confirmed by an abnormal electroencephalogram. Continued phenobarbital administration to the infant for 15 months controlled the seizures and no more occurred up to 5 years of age.[19] A 3-week-old infant whose mother was taking carbamazepine monotherapy 600 mg daily during pregnancy and postpartum had persistent jaundice from birth. Cholestasis and elevated hepatic transaminases were found. Jaundice slowly resolved after discontinuation of breastfeeding on day 17 of life, but transaminase values increased to a peak 6.5 weeks after discontinuation of breastfeeding. Cholestatic hepatitis was possibly caused by carbamazepine exposure in utero and in breastmilk.[20] An infant was born to a mother who was taking carbamazepine monotherapy 400 mg daily during pregnancy and postpartum. The infant was exclusively breastfed for 9 days, then partially breastfed. Jaundice was present at birth and serum gamma-glutamyltransferase (GGT) levels were elevated and remained elevated for at least 25 days, even after bilirubin levels decreased. The infant had a rare form of ABO incompatibility, but this was not thought to fully explain the elevated GGT levels. At 2, 4 and 6 months of age, the infant was developing normally. Serum carbamazepine levels were 1.8 and 1.1 mg/L at 2 days and 63 days of age. The transient hepatic dysfunction was possibly caused by carbamazepine exposure in utero and in breastmilk.[10] In a telephone follow-up study, mothers reported no side effects among 6 infants exposed to carbamazepine (ages and dosages not stated) in breastmilk.[21] One author reported a mother who was taking clonazepam 6 mg daily and carbamazepine 1400 mg daily. The infant had serum clonazepam levels of about 40% of the mother's serum level. Her infant was described as "somewhat lazy at the breast and tired." Carbamazepine levels were not repoted.[22] Possible drug-induced seizure-like activity and cyanosis occurred in a breastfed 3-week-old whose mother was taking fluoxetine, carbamazepine and buspirone during pregnancy and postpartum.[11] A breastfed 3-month-old whose mother was taking carbamazepine 200 mg in the morning and 300 mg at bedtime had normal liver function tests.[16] A fullterm infant whose mother was taking carbamazepine 400 mg daily during pregnancy and postpartum developed asphyxia at birth and required mechanical ventilation. Transient jaundice and liver enzyme elevation were attributed to asphyxia. The mother began breastfeeding on day 8 postpartum. At 3 to 7 weeks of age, cholestasis, jaundice and elevation of hepatic transaminases occurred. The late hepatic abnormalities were considered to be probably caused by carbamazepine in breastmilk.[23] Two infants were breastfed during maternal therapy with carbamazepine 600 and 1200 mg daily and levetiracetam. The infants appeared to remain healthy throughout the 6- to 8-week study period.[24] In a long-term study on infants exposed to anticonvulsants during breastfeeding, no difference in average intelligence quotient at 3 years of age was found between infants who were breastfed (n = 26) a median of 6 months and those

Relevant published information was not found as of the revision date. One woman on long-term carbamazepine therapy had slight galactorrhea 3.5 years after delivery, although her serum prolactin was normal.[8] The prolactin level in a mother with established lactation may not affect her ability to breastfeed.