Levetiracetam

Piracetam analog, nootropic and antiepileptic, authorized for use in Europe in infants from 1 month of life. Twice daily oral administration.

It is excreted in human milk in small amounts, much lower than the dose used in newborns and infants ^{(Kohn 2016, Tomson 2007, Johannesson 2005, Greenhill 2004, Kramer 2002)}, however, higher levels have also been found in human milk that exceed the safe limit of 10% of the relative infant dose, RID.^{(Dinavitser 2022 & 2021, Kohn 2016)}

Infant plasma levels are very low or undetectable. ^{(Kacirova 2021, Paret 2014, Tomson 2007, Johannesson 2005, Kramer 2002).}

In a comprehensive review, infant serum levels were 5 to 7 times lower than maternal levels and were below the reference range used for treatment. ^{(Kacirova 2021)}

No problems have been observed in infants whose mothers took it ^{(Dinavitser 2019, Lattanzi 2017, Tomson 2007, Johannesson 2005)}, except for hypotonia in a 7-day-old preterm, somnolence in three fully breastfed infants ^{(Dinavitser 2022)} and sedation and vomiting in a 25-day-old infant, whose mothers also took other antiepileptic drugs. ^{(Paret 2014, Kramer 2002)}

In one study, 15% of infants had sedation that resolved with partial breastfeeding. All infants gained well in weight. ^{(Dinavitser 2022 & 2021)}

Seizures such as neonatal withdrawal syndrome have been described in a non-breastfed newborn whose mother took Levetiracetam and phenobarbital during pregnancy. Symptoms disappeared when breastfeeding began. ^{(Rauchenzauner 2011)}

Levetiracetam serum levels decrease by 50% during pregnancy due to accelerated renal elimination. After delivery, concentrations rise to pre-pregnancy levels within a week, so it is advisable to decrease the dose administered to the mother and to monitor the newborn's clinical status. ^{(Reimers 2014, Lopez 2009, Harden 2009, Westin 2008, Tomson 2007)}

Various experts consider the use of this medication compatible or very likely compatible during breastfeeding. ^{(Hale 2019, Crettenand 2018, Briggs 2017, Rapcencu 2012, O'Connor 2009, Schaefer 2007, Pennell 2006, Pack 2006, Crawford 2008 and 2005, Greenhill, 2004)}

It is recommended to observe for sedation of infants. The transitional shift to partial breastfeeding can solve this problem.^{(Dinavitser 2022 & 2021)}