The Basics
What is Lamotrigine?
Used with other medications to treat certain types of seizures in patients who have epilepsy.
Brand names for Lamotrigine
Lamictal
How Lamotrigine is classified
Anticonvulsants, Antimanic Agents, Antidepressive Agents
Lamotrigine During Pregnancy
Lamotrigine pregnancy category
Category N/ANote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Lamotrigine while pregnant
There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to AEDs, including LAMICTAL, during pregnancy. Encourage women who are taking LAMICTAL during pregnancy to enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry by calling 1-888-233-2334 or visiting http://www.aedpregnancyregistry.org/.
Taking Lamotrigine While Breastfeeding
What are recommendations for lactation if you're taking Lamotrigine?
Breastfed infants have serum lamotrigine concentrations highly correlated with maternal serum and milk lamotrigine concentrations. It is important to monitor maternal serum lamotrigine concentration after delivery and adjust the dosage accordingly. Breastfeeding during lamotrigine 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 lamotrigine is required by the mother, it is not a reason to discontinue breastfeeding. Although most infants have been breastfed without adverse reactions, occasional adverse reactions have been reported in infants who receive lamotrigine in milk. Breastfed infants should be carefully monitored for side effects such as apnea, rash, drowsiness or poor sucking, including measurement of serum levels to rule out toxicity if there is a concern. Monitoring of the platelet count and liver function might also be advisable. If an infant rash occurs, breastfeeding should be discontinued until the cause can be established.
Maternal / infant drug levels
Breastfed infants have serum lamotrigine concentrations highly correlated with maternal serum and milk lamotrigine concentrations. It is important to monitor maternal serum lamotrigine concentration after delivery and adjust the dosage accordingly. Breastfeeding during lamotrigine 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 lamotrigine is required by the mother, it is not a reason to discontinue breastfeeding. Although most infants have been breastfed without adverse reactions, occasional adverse reactions have been reported in infants who receive lamotrigine in milk. Breastfed infants should be carefully monitored for side effects such as apnea, rash, drowsiness or poor sucking, including measurement of serum levels to rule out toxicity if there is a concern. Monitoring of the platelet count and liver function might also be advisable. If an infant rash occurs, breastfeeding should be discontinued until the cause can be established.
Possible effects of Lamotrigine on milk supply
Relevant published information was not found as of the revision date.
Possible alternatives to Lamotrigine
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. Meador KJ, Baker GA, Browning N et al. Breastfeeding in children of women taking antiepileptic drugs: Cognitive outcomes at age 6 years. JAMA Pediatr. 2014;168:729-36. PMID: 24934501
2. Rambeck B, Kurlemann G, Stodieck SRG et al. Concentrations of lamotrigine in a mother on lamotrigine treatment and her newborn child. Eur J Clin Pharmacol. 1997;51:481-4. PMID: 9112063
3. Tomson T, Ohman I, Vitols S. Lamotrigine in pregnancy and lactation: a case report. Epilepsia. 1997;38:1039-41. PMID: 9579945
4. Berry DJ. The disposition of lamotrigine throughout pregnancy. Ther Drug Monit. 1999;21:450. Abstract 90.
5. Ohman I, Vitols S, Tomson T. Lamotrigine in pregnancy: pharmacokinetics during delivery, in the neonate, and during lactation. Epilepsia. 2000;41:709-13. PMID: 10840403
6. Ohman I, Tomson T, Vitols S. Lamotrigine (LTG) pharmacokinetics during delivery and lactation. Ther Drug Monit. 1999;21:478. Abstract 201.
7. Page-Sharp M, Kristensen JH, Hackett LP et al. Transfer of lamotrigine into breast milk. Ann Pharmacother. 2006;40:1470-1. Letter. PMID: 16868219
8. Ivana K, Milan G, Blanka K, Hana B. Therapeutic monitoring of lamotrigine during delivery, in the neonatal period, and during lactation. Ther Drug Monit. 2007;29:477. Abstract 52. DOI: doi:10.1097/FTD.0b013e31813797e8
9. Newport DJ, Pennell PB, Calamaras MR et al. Lamotrigine in breast milk and nursing infants: determination of exposure. Pediatrics. 2008. PMID: 18591203
10. Fotopoulou C, Kretz R, Bauer S et al. Prospectively assessed changes in lamotrigine-concentration in women with epilepsy during pregnancy, lactation and the neonatal period. Epilepsy Res. Epilepsy Res. 2009;85:60-4. PMID: 19272754
11. Nordmo E, Aronsen L, Wasland K et al. Severe apnea in an infant exposed to lamotrigine in breast milk. Ann Pharmacother. 2009;43:1893-7. PMID: 19826099
12. Kohn E, Brandriss N, Soback S et al. Levetiracetam and lamotrigine excretion in breast milk. Reprod Toxicol. 2016;60:184. Abstract. DOI: doi:10.1016/j.reprotox.2016.03.032
13. Paulzen M, Stingl JC, Augustin M et al. Comprehensive measurements of intrauterine and postnatal exposure to lamotrigine. Clin Pharmacokinet. 2019;58:535-43. PMID: 30255309
14. Kacirova I , Grundmann M, Brozmanova H. A short communication: Lamotrigine levels in milk, mothers and breast-fed infants during the 1st postnatal month. Ther Drug Monit. 2019;41:401-4. PMID: 30688868
15. de Haan GJ, Edelbroek P, Segers J et al. Gestation-induced changes in lamotrigine pharmacokinetics: A monotherapy study. Neurology. 2004;63:571-3. PMID: 15304599
16. Liporace J, Kao A, D’Abreu A. Concerns regarding lamotrigine and breast-feeding. Epilepsy Behav. 2004;5:102-5. PMID: 14751214
17. Cibert M, Gouraud A, Vial T, Tod M. A physiologically-based pharmacokinetic model to predict neonate exposure to drugs during breast-feeding: application to lamotrigine. Fundam Clin Pharmacol. 2010;24 (Suppl 1):51. Abstract 246. DOI: doi:10.1111/j.1472-8206.2010.00819.x
18. Precourt A, Morin C. Use of lamotrigine during breastfeeding: Descriptive analysis of our population and report of five cases of premature neonates. Breastfeed Med. 2011;6 (Suppl 1):S-18. Abstract.
19. Clark CT, Klein AM, Perel JM et al. Lamotrigine dosing for pregnant patients with bipolar disorder. Am J Psychiatry. 2013;170:1240-7. PMID: 24185239
20. Bedussi F, Relli V, Faraoni L et al. 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. J Paediatr Child Health. 2018;54:104-5. PMID: 29314386
21. Johannessen SI, Helde G, Brodtkorb E. Levetiracetam concentrations in serum and in breast milk at birth and during lactation. Epilepsia. 2005;46:775-7. PMID: 15857447
22. Gentile S. Lamotrigine in pregnancy and lactation. Arch Women Ment Health. 2005;8:57-8. PMID: 15868389
23. Popescu L, Marceanu M, Moleavin I. Withdrawal of lamotrigine caused by sudden weaning of a newborn: a case report. Epilepsia. 2005;46 (Suppl 6):407. Abstract p1351. DOI: doi:10.1111/j.1528-1167.2005.460602.x
24. Wakil L, Epperson CN, Gonzalez J et al. Neonatal outcomes with the use of lamotrigine for bipolar disorder in pregnancy and breastfeeding: a case series and review of the literature. Psychopharmacol Bull. 2009;42:91-8. PMID: 19752842
25. Veiby G, Engelsen BA, Gilhus NE. Early child development and exposure to antiepileptic drugs prenatally and through breastfeeding: A prospective cohort study on children of women with epilepsy. JAMA Neurol. 2013;70:1367-74. PMID: 24061295
26. Vajda F. Epilepsy: Effects of exposure to antiepileptic drugs during development. Nat Rev Neurol. 2014;10:11-2. PMID: 24323050
27. Meador KJ, Baker GA, Browning N et al. Effects of breastfeeding in children of women taking antiepileptic drugs. Neurology. 2010;75:1954-60. PMID: 21106960
28. Soussan C, Gouraud A, Portolan G et al. Drug-induced adverse reactions via breastfeeding: a descriptive study in the French Pharmacovigilance Database. Eur J Clin Pharmacol. 2014;70:1361-6. PMID: 25183382
29. Prakash C, Hatters-Friedman S, Moller-Olsen C et al. Maternal and fetal outcomes after lamotrigine use in pregnancy: A retrospective analysis from an urban maternal mental health centre in New Zealand. Psychopharmacol Bull. 2016;46:63-69. PMID: 27738382
30. Levesque S, Riley C. Fetal exposure to lamotrigine and quetiapine in two consecutive pregnancies. Arch Womens Ment Health. 2017;20:237-9. PMID: 27785634
31. Sharma V, Sommerdyk C. Lamotrigine in the prevention of bipolar II postpartum depression. Prim Care Companion CNS Disord. 2016;18 (6). Letter. PMID: 27907274
32. Morin C, Chevalier I. Severe hypernatremic dehydration and lower limb gangrene in an infant exposed to lamotrigine, aripiprazole, and sertraline in breast milk. Breastfeed Med. 2017;12:377-80. PMID: 28481632
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
