Is Topiramate Safe in Breastfeeding

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

Anticonvulsant used for treatment of epilepsy and migraine prophylaxis. It is moderately excreted into breast milk with the infant receiving just over 10% of the maternal weight-adjusted dose. Neither clinical nor psychomotor developmental effects have been observed in infants whose mothers were treated. Only a possibly related case of gastroenteritis that resolved after discontinuation of mother’s medication.Plasma levels of infants whose mothers were treated with topiramate have shown to be undetectable or pretty below (<1 mg / L) the recommended therapeutic level (5-20 mg / L). Check up the occurrence of diarrhea, irritability and lethargy in infants

Limited information indicates that maternal doses of topiramate up to 200 mg daily produce relatively low levels in infant serum. Monitor the infant for diarrhea, drowsiness, irritability, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of anticonvulsant or psychotropic drugs.

No adverse effects were observed in 3 infants who were breastfed from birth and observed for at least 24, 27 and 97 days.[1] The authors reported 3 additional breastfed infants who also had no adverse effects.[4] An exclusively breastfed infant whose mother was taking topiramate 300 mg, levetiracetam 2 g, and valproate 1.8 g daily during pregnancy and lactation appeared healthy to the investigators throughout the 6- to 8-week study period.[5] One woman breastfed her infant for 13 months while she was taking topiramate for epilepsy. She took a daily dosage of 150 to 175 mg for the first 6 months, then 200 mg daily. At 1 year of age, the infant was developing normally and both parents stated that no side effects such as tiredness had been observed in the infant.[2] A woman who took topiramate 300 mg daily throughout pregnancy delivered a normal, healthy infant. She reportedly breastfed her infant exclusively for 8 months at which time no adverse drug effects or neurodevelopmental delay were noted by the infant's pediatrician.[6]The breastfed infant of a mother who was taking 100 mg of topiramate daily developed watery, foamy stools with 8 to 10 bowel movements daily at 40 days of age. The infant's rate of weight gain also declined. Topiramate was detected in breastmilk at a relatively high concentration. Two weeks later, breastfeeding was discontinued. Within 24 hours, the stool frequency declined to 2 to 3 times daily, more solid and the color and odor normalized.[3] Topiramate was the probable cause of the diarrhea in the infant.