Lynn,
Thank you for emailing regarding your concerns about the potential effect the following could have on breastfeeding.

When considering a medication to be used by the mom while breastfeeding, we consider three issues: the health of the baby, the age of the baby and the medication. The age of the baby is very important, because if there is a concern, it is often with newborns (less than two months old). Doctors are most concerned about medications that could cause poor weight gain at this critical time for the baby or cause complications that could affect the babies growth/weight including diarrhea, vomiting, poor eating, etc.

You called us about Keppra and Zonegran in breastfeeding.
According to LactMed, "Maternal doses of levetiracetam (Keppra) up to 3500 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. If levetiracetam is required by the mother, it is not a reason to discontinue breastfeeding. However, the infant should be monitored for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of anticonvulsants. Maternal serum level monitoring and dosage adjustment is advisable in the early postpartum period if the drug was taken throughout pregnancy and breastfeeding."

What this means is that levetiracetam can be taken while breastfeeding your baby, however, its important to look out for symptoms that suggest the baby is either 1) having a build up of medication in his/her body and 2) interfering with the infants ability to put on weight. If the mother desires to breastfeed, and concerns do come up about the exposure to these meds, the baby can be tested (blood test) to check for the amount of medication in the bloodstream.

Re zonisamide, Lactmed reports: "Very limited information indicates that maternal doses of zonisamide up to 400 mg daily produce relatively high levels in milk, but serum levels in neonates decrease during the first month of life while nursing. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of anticonvulsant drugs. Measurement of an infant serum level might help rule out toxicity if there is a concern."

Zonisamide is found in higher levels in breastmilk, suggesting it is more likely to be a concern for the infant. If you decide to use it while breastfeeding, a blood test would be indicated for the infant to check for levels of the drug. This is particularly the case for baby's less than 2 months old.

You can read more about this at LactMed - the source we use and recommend.
http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

If your baby is premature or is born low birth weight (5 ∏ lbs or less), or your baby is less than two months old, then the decision about whether to breastfeed while taking a specific drug is probably best decided between the mother and neonatologist or pediatrician. Together with your specialist, you can weigh the benefits to the baby from the breast milk and any potential concerns.

If you have any questions about the use of these medications in pregnancy, please email  us and we'll be happy to send you the information available at this time.

If you have additional questions regarding breastfeeding, please feel free to call us at 800-532-3749 or, you can visit http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT enter the name of the drug and read the information provided by experts.  If you notice any symptoms that seem unusual for your baby, consult with your pediatrician.


Sonia Alvarado
Teratogen Information Specialist, Supervisor