Epilepsy - Medications

(Page 5)

• Women with epilepsy should consider taking only one AED during their pregnancy to reduce the risk of birth defects. Taking more than one AED may increase birth defect risk. Carbamazepine is generally considered to be the safest AED for use during pregnancy.
• Of all AEDs, valproate carries the highest risk for birth defects and should be avoided, if possible, during the first trimester. Valproate use has been associated with neural tube defects, facial clefts (cleft lip or palate), and in boys hypospadias (abnormal position of urinary opening on the penis). Valproate, as well as phenytoin and phenobarbital, may cause poor cognitive outcomes in children.
• Pregnancy can affect how an AED is metabolized in your body. AED levels tend to drop during pregnancy. Your doctor should monitor your blood levels throughout your pregnancy to see if your dosage needs to be adjusted. This is especially important if you take lamotrigine, carbamazepine, or phenytoin.

---

---

Breastfeeding. If women on AEDs breast-feed they should be aware that some types of AEDs are more likely than others to pass into the breast milk. The following AEDs appear to be the most likely to pass into breast milk in clinically important amounts: Primidone, levetiracetam, and possibly gabapentin, lamotrigine, and topiramate. In contrast, valproate, phenobarbital, and phenytoin do not appear to pass into breast milk in significant amounts. A mother should watch for signs of lethargy or extreme sleepiness in her infant, which could be caused by her medication.

Review Date: 01/28/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).