Comprehensive Epilepsy Center
Women's Health - Breast Feeding and AEDs
Fact of the Day: Breast milk is the ultimate baby food! It has all the nutrients a growing infant needs, plus it helps protect
the baby against illness.
Many women with epilepsy can safely breastfeed their babies. You should discuss breastfeeding with both your neurologist and
obstetrician. Several things need to be taken into consideration.
How much medication will end up in the breast milk?
This differs from drug to drug. In general, if an antiepileptic drug (AED) binds strongly to proteins in the body, less will
end up in the milk. The mother’s AED level can also effect the concentration of the drug in milk. You or your doctor can use
an equation to estimate the concentration of SED in milk.
Mom’s AED level (mcg/ml) x 800 ml milk (average amount in 24 hrs) x ratio of serum to breast milk concentration ¸ 1000 AED
(mg) in milk over 24 hours
For example, if a woman has a Tegretol level of 8.0 mcg/ml, then: 8mcg/ml x 800 ml x 0.40 ¸ 1000 = 2.56 mg in breast milk
in 24 hours to baby
| AED |
Serum concentrationIn breast milk |
| Carbamazepine (Tegretol) |
40% |
| Ethosuximide (Zarontin) |
90% |
| Gabapentin (Neurontin) |
73% |
| Lamotrigine (Lamictal) |
60% |
| Phenobarbitol |
36% |
| Phenytoin (Dilantin) |
18% |
| Primidone (Mysoline) |
70% |
| Valproic Acid (Depakote, Depakene) |
5% |
| Topiramate (Topamax) |
86% |
| Keppra |
Unknown |
| Zonegran |
Unknown |
Will the baby need blood levels too?
Depending on the AED, the pediatrician may want blood levels on the baby. It is usually recommended that infants of moms taking
Phenobarbitol, Mysoline, or the newer AEDs have occasional AED levels. This is because babies cannot process medication as
well as adults, and drugs may accumulate in the baby’s system.
What if I have a seizure while breastfeeding?
Other moms with epilepsy say nursing in a large, padded armchair is the best strategy. If you know that you may wander or
fall with your seizures, always have another person close by during feeding times.
