Last update: July 31, 2017
Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
Read the Comment.
Zonisamide is excreted in breast milk in amounts that could be clinically significant, since the infant receives a relative dose well above 10% (Pack 2006, Crawford 2005, Tomson 2005, Shimoyama 1999, Kimura 1998).
In spite of this high excretion in breast milk, infants who were breastfed by mothers taking zonisamide had no clinical problems (Shimoyama 1999) and their plasma zonisamide levels were only 15 to 17% of those measured in the mother (Kawada 2002, abstracts-P55 2011).
Due to poor pharmacokinetics for breastfeeding with low protein binding and slow drug elimination (Jacob 2016) and the limited existing literature in relation to breastfeeding (Reimers 2014), it may be advisable to choose antiepileptics whose safety is better known (Hutchinson 2013, Davanzo 2013).
If it is administered during breastfeeding, use the minimum effective dose (Reimers 2014) and monitor the infant's appetite, weight curve, psychomotor development, irritability, diarrhea, dehydration or acidosis, and it may be desirable to measure monthly plasma levels in the infant (Davanzo 2013, Pennell 2003).
Some authors propose partial breastfeeding to decrease the dose that the infant receives through breast milk (Ando 2014).
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.
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