Last update: Dec. 27, 2019

Levetiracetam

Very Low Risk for breastfeeding


Safe. Compatible.
Not risky for breastfeeding or infant.

Piracetam analog with nootropic and anti-epileptic effect. Authorized for use in children from 1 month of age in Europe.
Oral administration twice daily.

It is excreted in breast milk in small amounts, much lower than the dose used for newborns and infants (Kohn 2016, Tomson 2007, Johannesson 2005, Greenhill 2004, Kramer 2002). The plasma levels of infants whose mothers take them are low or undetectable, less than usual therapeutic levels (Paret 2014, Tomson 2007, Johannesson 2005, Kramer 2002).
No problems have been observed in infants whose mothers have taken it (Lattanzi 2017, Tomson 2007, Johannesson 2005), except one case of hypotonia in a 7 days old premature, and sedation and vomiting in a 25-day infant, whose mothers also took other anti epileptic drugs (Paret 2014, Kramer 2002).

Seizures along with neonatal abstinence syndrome in a botlle fed neonate whose mother had taken Levetiracetam and Phenobarbital in pregnancy ocurred. Symptoms disappeared after initiation of breastfeeding (Rauchenzauner 2011).

Serum levetiracetam levels decrease by 50% during pregnancy due to accelerated renal elimination. After delivery, the concentrations rise to pre-pregnancy levels in a week, so it is advisable to reduce the dose given to the mother and monitor the clinical condition of the newborn (Reimers 2014, Lopez 2009, Harden 2009, Westin 2008, Tomson 2007).

Several experts consider the use of this medication to be safe or very probably safe during breastfeeding (Hale 2019, Crettenand 2018, Briggs 2017, Rapcencu 2012, O'Connor 2009, Schaefer 2007, Pennell 2006, Pack 2006, Crawford 2008 y 2005, Greenhill, 2004).

Alternatives

We do not have alternatives for Levetiracetam since it is relatively safe.

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Levetiracetam in other languages or writings:

Group

Levetiracetam belongs to this group or family:

Tradenames

Main tradenames from several countries containing Levetiracetam in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 100 %
Molecular weight 170 daltons
Protein Binding 10 %
VD 0,5 - 0,7 l/Kg
Tmax 1,3 hours
T1/2 6 - 8 hours
M/P ratio 0,9 - 3 -
Theoretical Dose 2 - 3,9 mg/Kg/d
Relative Dose 4 - 8 %
Relat.Ped.Dose 5 - 10 %

References

  1. Hale TW. Hale's Medications & Mothers' Milk. Springer Publishing Company. 2019
  2. Crettenand M, Rossetti AO, Buclin T, Winterfeld U. [Use of antiepileptic drugs during breastfeeding : What do we tell the mother?] Nervenarzt. 2018 Abstract
  3. Lattanzi S, Cagnetti C, Foschi N, Provinciali L, Silvestrini M. Lacosamide during pregnancy and breastfeeding. Neurol Neurochir Pol. 2017 May - Jun;51(3):266-269. Abstract
  4. Jacob S, Nair AB. An Updated Overview on Therapeutic Drug Monitoring of Recent Antiepileptic Drugs. Drugs R D. 2016 Abstract Full text (link to original source) Full text (in our servers)
  5. Kohn E, Brandriss N, Soback S, Bar-Haim A, Berkovitch M. Levetiracetam and lamotrigine excretion in breast milk. Reprod Toxicol. 2016;60:184. 2016
  6. European Medicines Agency. Levetiracetam. Drug summary 2014 Full text (in our servers)
  7. Paret N, Gouraud A, Bernard N, Bruel M, Cottin J, Descotes J, Vial T. Long-term follow-up of infants exposed to levetiracetam during breastfeeding: Comparison to a control group. (The 2nd International OTIS-ENTIS Conference at The Hospital for Sick Children, Toronto, Canada) Birth Defects Res A Clin Mol Teratol. 2014;100:537-8. Abstract 38. DOI: doi:10.1002/bdra.23258 2014
  8. Reimers A. New antiepileptic drugs and women. Seizure. 2014 Abstract Full text (link to original source) Full text (in our servers)
  9. Agencia europea del medicamento. Levetiracetam. Ficha técnica. 2014 Full text (in our servers)
  10. Rapcencu AE, Lindhout D, Bulk S. Frequently asked questions on epilepsy, pregnancy and lactation: a EURAP-NL report. Seizure. 2012 Abstract Full text (link to original source) Full text (in our servers)
  11. Rauchenzauner M, Kiechl-Kohlendorfer U, Rostasy K, Luef G. Old and new antiepileptic drugs during pregnancy and lactation--report of a case. Epilepsy Behav. 2011 Abstract
  12. Crawford PM. Managing epilepsy in women of childbearing age. Drug Saf. 2009 Abstract
  13. Harden CL, Pennell PB, Koppel BS, Hovinga CA, Gidal B, Meador KJ, Hopp J, Ting TY, Hauser WA, Thurman D, Kaplan PW, Robinson JN, French JA, Wiebe S, Wilner AN, Vazquez B, Holmes L, Krumholz A, Finnell R, Shafer PO, Le Guen C; American Academy of Neurology; et al. Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): vitamin K, folic acid, blood levels, and breastfeeding: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of... Neurology. 2009 Abstract Full text (link to original source) Full text (in our servers)
  14. O'Connor SE, Zupanc ML. Women and epilepsy. J Pediatr Pharmacol Ther. 2009 Abstract Full text (link to original source) Full text (in our servers)
  15. López-Fraile IP, Cid AO, Juste AO, Modrego PJ. Levetiracetam plasma level monitoring during pregnancy, delivery, and postpartum: clinical and outcome implications. Epilepsy Behav. 2009 Abstract
  16. Westin AA, Reimers A, Helde G, Nakken KO, Brodtkorb E. Serum concentration/dose ratio of levetiracetam before, during and after pregnancy. Seizure. 2008 Mar;17(2):192-8. Abstract
  17. Tomson T, Palm R, Källén K, Ben-Menachem E, Söderfeldt B, Danielsson B, Johansson R, Luef G, Ohman I. Pharmacokinetics of levetiracetam during pregnancy, delivery, in the neonatal period, and lactation. Epilepsia. 2007 Jun;48(6):1111-6. Epub 2007 Mar 22. Abstract Full text (link to original source) Full text (in our servers)
  18. Schaefer C, Peters P, Miller RK. Drugs During Pregnancy and Lactation. Treatment options and risk assessment. Elsevier, second edition. London. 2007
  19. Pack AM. Therapy insight: clinical management of pregnant women with epilepsy. Nat Clin Pract Neurol. 2006 Abstract
  20. Pennell PB. Is breast milk the best for babies of mothers on levetiracetam? Epilepsy Curr. 2006 Abstract
  21. Pennell PB. 2005 AES annual course: evidence used to treat women with epilepsy. Epilepsia. 2006 Abstract Full text (link to original source) Full text (in our servers)
  22. O'Brien MD, Gilmour-White SK. Management of epilepsy in women. Postgrad Med J. 2005 Abstract Full text (link to original source) Full text (in our servers)
  23. Tomson T. Gender aspects of pharmacokinetics of new and old AEDs: pregnancy and breast-feeding. Ther Drug Monit. 2005 Abstract
  24. Crawford P. Best practice guidelines for the management of women with epilepsy. Epilepsia. 2005 Abstract Full text (link to original source) Full text (in our servers)
  25. Johannessen SI, Helde G, Brodtkorb E. Levetiracetam concentrations in serum and in breast milk at birth and during lactation. Epilepsia. 2005 Abstract Full text (link to original source) Full text (in our servers)
  26. Greenhill L, Betts T, Yarrow H et al. Breast milk levels of levetiracetam after delivery. Epilepsia. 2004;45 (suppl 7):230. Abstract 2115. 2004 Full text (in our servers)
  27. Pennell PB. Antiepileptic drug pharmacokinetics during pregnancy and lactation. Neurology. 2003 Abstract
  28. Kramer G, Hosli I, Glanzmann R et al. Levetiracetam accumulation in human breast milk. Epilepsia. 2002;43 (Suppl 7):105. Abstract 1288. 2002 Full text (in our servers)

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