Concentrations of antiseizure medications in breast milk of lactating women with epilepsy: A systematic review with qualitative synthesis

  • Ramzi Shawahna
    Corresponding author at: Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, New Campus, An-Najah National University, P.O. Box 7, Nablus, Palestine.
    Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, New Campus, An-Najah National University, P.O. Box 7, Nablus, Palestine

    An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine
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  • Lina Zaid
    Master of Pharmacology Program, Faculty of Graduate Studies, An-Najah National University, Nablus, Palestine
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      • A total of 15 articles reporting on antiseizure medications (ASMs) in human milk were systematically reviewed.
      • The calculated relative infant doses were less than 10% for the majority of the ASMs.
      • Breastfeeding might be limited or discontinued in case of excessive sedation/drowsiness and/or poor weight gain.



      Recent position papers and guidelines encourage women with epilepsy (WWE) to exclusively breastfeed their infants because the benefits to their infants outweigh the potential adverse effects caused by exposure to antiseizure medications (ASMs).


      The objectives of this review were: to evaluate concentrations of ASMs in breastmilk of lactating WWE, qualitatively synthesize evidence that can be used to estimate theoretical doses as estimated daily intake (EDI) and relative infant dose (RID) of ASMs, and to evaluate potential risks to infants as a result of exposure to ASMs from breastmilk.


      This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) as CRD42020223645. The databases: MEDLINE/PubMed, EMBASE, CINAHL/EBSCO, COCHRANE, SpringerLink, ScienceDirect, Summon, WHO International Clinical Trials Registry Platform, and SCOPUS were systematically searched. A qualitative synthesis was adopted in this study.


      A total of 15 records were included in this systematic review. The included studies reported levels of 8 ASMs in the breastmilk of WWE. The highest RIDs of carbamazepine, lamotrigine, primidone, phenobarbital, gabapentin, valproic acid, ethosuximide, levetiracetam, and topiramate were 3.70%, 36.33%, 4.96%, 3.15%, 4.37%, 1.90%, 31.49%, 12.50%, and 12.18%, respectively. Breastfeeding might be limited or even discontinued when signs of excessive sedation/drowsiness and/or poor weight gain are evident on infants exposed to primidone and phenobarbital, ethosuximide/primidone, or ethosuximide/phenobarbital.


      Concentrations of ASMs can be detected in breastmilk of WWE and plasma/serum of infants exposed via breastmilk. Healthcare providers and WWE might use the findings of this study to make informed decisions on the safety of breastfeeding while taking ASMs.


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