Last update: Oct. 31, 2018
Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
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An antiepileptic indicated in partial-onset epileptic seizures (EMA2107, FDA 2014).
Off-label it is used to treat neuropathic pain, fibromyalgia, osteoarthritis and migraine prophylaxis (Alcántara 2016, Moulin 2014, Gómez 2014), although with disputed evidence of its effectiveness (Wiffen 2013, McCleane 2013). Oral administration twice a day.
Its pharmacokinetic data (low molecular weight, low protein binding, high pKa) explains the potentially significant amounts transferred to breastmilk, with a very high relative dose, around 19% (Zárubová 2016).
However, other authors have found minimal excretion in the breastmilk of a mother who took lacosamide and levetiracetam throughout pregnancy and at the beginning of breastfeeding, with a relative dose of 1.8%. The mother stopped breastfeeding at 15 days due to drowsiness and insufficient feeding in the infant, who was born premature at 36 weeks, although the plasma levels in the infant were very low. At 7 months the infant showed good psychomotor development (Ylikotila 2015).
No problems of somatic or psychomotor development were observed at 18, 24 and 36 months of age in three infants whose mothers took lacosamide at doses of 300 and 400 mg/day in mono or polytherapy for 7, 8 and 9 months. Levels were not measured in milk or in the infants (Lattanzi 2017).
Until there is more published data on this drug in relation to breastfeeding, safer known alternatives may be preferable, especially during the neonatal period and in case of prematurity.
Given the strength of existing evidence on the benefits of breastfeeding for the development of babies and the health of mothers, it is advisable to evaluate the risk-benefit of this medication, advising mothers who wish to continue breastfeeding on an individual basis (Crettenand 2018).
Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
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