Q:  Topamax & Breastfeeding

My Doctor just prescribed Topomax. I am 40 and the mother of two young babies still nursing. Is this drug safe to take while nursing? I must admit I have not done so yet. *paranoid* My neurolgist tells me his peers say it is safe to take while nursing, but he would not recommend any drug that would affect developing brains and minds, *my babies thru the nursing* as that is a lawsuit waiting to happen. I do not know if he is just being over  cautious.

Thank-you
 

Dear Ms. M' -- 
How much topiramate gets in your milk?  Quite a bit, about 80% the concentration of the medication in your bloodstream. How much gets in junior? Well, it would be nice if we had more to go on.  For example, in one recent study, the number of kids studied was....three.  Here's what they found: 

2 to 3 weeks after delivery, two of the breast-fed infants had detectable (>0.9 microM) concentrations of TPM, although below the limit of quantification (2.8 microM), and one had an undetectable concentration.

Below the limit of quantification means they found some all right, but the instrument doesn't measure accurately just how much when the amount is that low; and as you see, 1 of three children had none despite the amount in mothers' milk. 

So, does that mean it's safe?  What are these kids like when they're 5?  Are they any different than other kids then?  How about when they're 10?  

Well, believe it or not, we don't have that information even for the really commonly used medications like antidepressants, except for Prozac, which is so common, there has actually been a study following the kids who were exposed in the uterus and thereafter -- and they have all turned out fine, no different than a bunch of similar kids not exposed. 

So, it's very hard to say "it's safe" about anything; but we can say "not much of it in junior's blood while you're breastfeeding even though there's quite a bit in your milk".  And that's supposed to help, I hope, even though I know it didn't really completely answer your question. 

Dr. Phelps

Published September, 2003