OBJECTIVE: To provide additional information on the transport of the new anti-seizure medications lacosamide, perampanel, and zonisamide in breast milk and breastfed infants. METHODS: Between 2013 and 2022, concentrations of anti-seizure medications were measured in six women with epilepsy (each drug in two patients) using high-performance liquid chromatography. Additionally, concentrations were determined after two consecutive pregnancies in women receiving lacosamide and one woman receiving zonisamide. In all cases, anti-seizure medication concentrations were measured in the maternal serum and breast milk, and five cases, in the infant serum. RESULTS: For lacosamide, the ratios of breast milk/maternal serum concentration varied between 0.77 and 0.93, the ratios of infant/maternal serum concentrations were 0.16 and 0.35, and the ratios of infant serum/milk concentrations were 0.21 and 0.38. For perampanel, the ratios of breast milk/maternal serum concentration were 0.01 and 0.10 and the ratio of infant/maternal serum concentration was 0.36. For zonisamide, the ratios of breast milk/maternal serum concentration varied between 0.76 and 1.26, the ratios of infant/maternal serum concentrations between 0.44 and 0.85, and the ratios of infant serum/milk concentrations between 0.55 and 1.05. CONCLUSIONS: Breastfeeding is recommended for women using lacosamide, perampanel, and zonisamide. However, the actual exposure can only be accurately evaluated by determining the serum concentration of anti-seizure medication in breastfed infants.
- Klíčová slova
- Breastfeeding, Concentration, Lacosamide, Monitoring, Perampanel, Zonisamide,
- MeSH
- kojenec MeSH
- kojení * škodlivé účinky MeSH
- lakosamid MeSH
- lidé MeSH
- nitrily * MeSH
- pyridony * MeSH
- těhotenství MeSH
- zonisamid MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- lakosamid MeSH
- nitrily * MeSH
- perampanel MeSH Prohlížeč
- pyridony * MeSH
- zonisamid MeSH
OBJECTIVES: The benefits of breastfeeding are generally accepted. Risk of drug usage for baby due to lactation is well assessed minimally in certain cases. However, information given about drugs are often insufficient, frustrating, and not recommending lactation. In Czech Teratology Information Service (CZTIS) counselling we use these information. RESULTS: We have given advice in 58 cases inquiring the CZTIS about the risk of drug exposure during lactation. The most frequent queries were on chronic disease treatment following the drug exposure during pregnancy. Remaining cases were associated with acute infections. Mothers suffered from idiopathic bowel disease and psychiatric patients want to be informed before delivery about possibility to breastfeed their babies. Treatment of epilepsy, another frequent disease, is associated with better level of knowledge of both, neurologists and patients. Breastfeeding is recommended according to management in care of epileptic women. CONCLUSION: In our counselling we consider the factors which are involved in drug transfer in the milk and mechanisms and steps of transfer as well. We follow the classification of drugs during lactation by their effect on infants: absolutely contraindicated, temporary cessation of breastfeeding, drugs of special concern and drugs compatible with breastfeeding.
- MeSH
- antiinfekční látky lokální škodlivé účinky metabolismus MeSH
- antikonvulziva škodlivé účinky farmakokinetika MeSH
- biologická dostupnost MeSH
- dospělí MeSH
- epilepsie komplikace MeSH
- informační služby o lécích statistika a číselné údaje MeSH
- kojení škodlivé účinky MeSH
- kyseliny borité škodlivé účinky metabolismus MeSH
- léčivé přípravky metabolismus MeSH
- lidé MeSH
- mateřské mléko chemie MeSH
- nežádoucí účinky léčiv * MeSH
- novorozenec MeSH
- poločas MeSH
- těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
- Názvy látek
- antiinfekční látky lokální MeSH
- antikonvulziva MeSH
- boric acid MeSH Prohlížeč
- kyseliny borité MeSH
- léčivé přípravky MeSH
