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 |