Managing antiepileptic drugs during pregnancy and lactation

PURPOSE OF REVIEW: This review discusses data on the pharmacokinetics of antiepileptic drugs (AEDs) in pregnancy and lactation, and the clinical consequences thereof, thus providing a basis for a rational management of AEDs during pregnancy and lactation. RECENT FINDINGS: Studies have confirmed that the elimination of lamotrigine and the active metabolite of oxcarbazepine is enhanced during pregnancy. It has been established that the increased clearance of lamotrigine is caused by induction of glucuronidation. Also, the plasma concentrations of levetiracetam decline in pregnancy but the mechanism for this effect is yet to be explored. Lamotrigine is eliminated slowly in breast-fed infants, but although lamotrigine concentrations in the infant can reach pharmacological levels, no studies have reported clinically relevant adverse effects caused by lactation. SUMMARY: Knowledge of the pharmacokinetics of AEDs in pregnancy and during lactation is important to enable optimal treatment. Gestation induced alterations in pharmacokinetics vary with the AED but also between patients and are difficult to predict. Therapeutic drug monitoring is, therefore, advisable during pregnancy and the use of the individual patient's optimal prepregnancy drug level is recommended as reference. Breastfeeding is in general safe but needs appropriate observation of the nursing infant.