Last update: Nov. 17, 2014

Carbamazepine

Very Low Risk for breastfeeding


Safe. Compatible.
Not risky for breastfeeding or infant.

Excreted into breast milk in moderate amount that could arrive to be significant.

Most infants reported were not found of suffering clinical issues at short or long term. However, serum levels have reached a low range of therapeutic levels, with isolated cases of somnolence, poor feeding and transient liver dysfunction with associated cholestasis.

One case of Deprivation Syndrome has been reported after sudden discontinuation of medication.

The American Academy of Pediatrics rates it as usually compatible with Breastfeeding.

Eleventh WHO Model List of Essential Drugs 2002: Compatible with breastfeeding.

Alternatives

We do not have alternatives for Carbamazepine since it is relatively safe.

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.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Group

Carbamazepine belongs to this group or family:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 100 %
Molecular weight 236 daltons
Protein Binding 74 %
Tmax 5 hours
T1/2 54 hours
M/P ratio 0,7 -
Theoretical Dose 0,57 - 1,35 mg/Kg/d
Relative Dose 4 - 7 %
Relat.Ped.Dose 3,75 - 6,75 %

References

  1. Crettenand M, Rossetti AO, Buclin T, Winterfeld U. [Use of antiepileptic drugs during breastfeeding : What do we tell the mother?] Nervenarzt. 2018 Abstract
  2. Grover S, Avasthi A. Mood stabilizers in pregnancy and lactation. Indian J Psychiatry. 2015 Abstract Full text (link to original source) Full text (in our servers)
  3. Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Privitera M, Loring DW; Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) Study Group. Breastfeeding in children of women taking antiepileptic drugs: cognitive outcomes at age 6 years. JAMA Pediatr. 2014 Abstract Full text (link to original source) Full text (in our servers)
  4. Veiby G, Engelsen BA, Gilhus NE. Early child development and exposure to antiepileptic drugs prenatally and through breastfeeding: a prospective cohort study on children of women with epilepsy. JAMA Neurol. 2013 Abstract Full text (link to original source) Full text (in our servers)
  5. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  6. Davanzo R, Dal Bo S, Bua J, Copertino M, Zanelli E, Matarazzo L. Antiepileptic drugs and breastfeeding. Ital J Pediatr. 2013 Abstract Full text (link to original source) Full text (in our servers)
  7. Rapcencu AE, Lindhout D, Bulk S. Frequently asked questions on epilepsy, pregnancy and lactation: a EURAP-NL report. Seizure. 2012 Abstract Full text (link to original source) Full text (in our servers)
  8. Lopes BR, Barreiro JC, Baraldi PT, Cass QB. Quantification of carbamazepine and its active metabolite by direct injection of human milk serum using liquid chromatography tandem ion trap mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci. 2012 Abstract
  9. Mercadé Cerdá JM, Sancho Rieger J, Mauri Llerda JA, López González FJ,Salas Puig X. Guías diagnósticas y terapéuticas de la Sociedad Española de Neurología 2012. 1. Guía oficial de práctica clínica en epilepsia. Guías SEN 2012 Full text (in our servers)
  10. Mintzer S. To test our guess that breast is best: anticonvulsants and breastfeeding. Epilepsy Curr. 2011 Abstract Full text (link to original source) Full text (in our servers)
  11. Grundmann M, Kacirova I, Duricova J, Perinova I. Metoprolol and alfa-hydroxymetoprolol concentrations during lactation - a case report. 12th International Congress of Therapeutic Drug Monitoring and Clinical Toxicology Stuttgart, Germany · October 2-6, 2011. Poster 088. Ther Drug Monit. 2011;33:504. P088. 2011
  12. Meador KJ, Baker GA, Browning N, Clayton-Smith J, Combs-Cantrell DT, Cohen M, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Privitera M, Loring DW; NEAD Study Group. Effects of breastfeeding in children of women taking antiepileptic drugs. Neurology. 2010 Abstract Full text (link to original source) Full text (in our servers)
  13. Zhao M, Yang L, Wei Y, Xiong X, Zhou Y, Zhai SD. [A case report of monitoring on carbamazepine in breast feeding woman]. Beijing Da Xue Xue Bao. 2010 Abstract Full text (link to original source) Full text (in our servers)
  14. O'Connor SE, Zupanc ML. Women and epilepsy. J Pediatr Pharmacol Ther. 2009 Abstract Full text (link to original source) Full text (in our servers)
  15. Harden CL, Pennell PB, Koppel BS, Hovinga CA, Gidal B, Meador KJ, Hopp J, Ting TY, Hauser WA, Thurman D, Kaplan PW, Robinson JN, French JA, Wiebe S, Wilner AN, Vazquez B, Holmes L, Krumholz A, Finnell R, Shafer PO, Le Guen C; American Academy of Neurology; et al. Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): vitamin K, folic acid, blood levels, and breastfeeding: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of... Neurology. 2009 Abstract Full text (link to original source) Full text (in our servers)
  16. Sharma V, Burt VK, Ritchie HL. Bipolar II postpartum depression: Detection, diagnosis, and treatment. Am J Psychiatry. 2009 Abstract Full text (link to original source) Full text (in our servers)
  17. Even C, Dorocant ES, Thuile J, Kalck-stern M, Guelfi JD. [Pregnancy, breast feeding and mood stabilisers: review and recommendations for practice]. Encephale. 2006 Abstract
  18. Pennell PB. 2005 AES annual course: evidence used to treat women with epilepsy. Epilepsia. 2006 Abstract Full text (link to original source) Full text (in our servers)
  19. Pack AM. Therapy insight: clinical management of pregnant women with epilepsy. Nat Clin Pract Neurol. 2006 Abstract
  20. O'Brien MD, Gilmour-White SK. Management of epilepsy in women. Postgrad Med J. 2005 Abstract Full text (link to original source) Full text (in our servers)
  21. Tomson T. Gender aspects of pharmacokinetics of new and old AEDs: pregnancy and breast-feeding. Ther Drug Monit. 2005 Abstract
  22. Crawford P. Best practice guidelines for the management of women with epilepsy. Epilepsia. 2005 Abstract Full text (link to original source) Full text (in our servers)
  23. Rubin ET, Lee A, Ito S. When breastfeeding mothers need CNS-acting drugs. Can J Clin Pharmacol. 2004 Fall;11(2):e257-66. Epub 2004 Dec 8. Abstract
  24. Pennell PB. Antiepileptic drug pharmacokinetics during pregnancy and lactation. Neurology. 2003 Abstract
  25. Frey B, Braegger CP, Ghelfi D. Neonatal cholestatic hepatitis from carbamazepine exposure during pregnancy and breast feeding. Ann Pharmacother. 2002 Abstract
  26. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  27. Iqbal MM, Sohhan T, Mahmud SZ. The effects of lithium, valproic acid, and carbamazepine during pregnancy and lactation. J Toxicol Clin Toxicol. 2001 Abstract
  28. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Abstract Full text (link to original source) Full text (in our servers)
  29. Shimoyama R, Ohkubo T, Sugawara K. Monitoring of carbamazepine and carbamazepine 10,11-epoxide in breast milk and plasma by high-performance liquid chromatography. Ann Clin Biochem. 2000 Abstract
  30. Chaudron LH. When and how to use mood stabilizers during breastfeeding. Prim Care Update Ob Gyns. 2000 Abstract
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  32. Hägg S, Spigset O. Anticonvulsant use during lactation. Drug Saf. 2000 Jun;22(6):425-40. Review. Abstract
  33. Brent NB, Wisner KL. Fluoxetine and carbamazepine concentrations in a nursing mother/infant pair. Clin Pediatr (Phila). 1998 Abstract
  34. Wisner KL, Perel JM. Serum levels of valproate and carbamazepine in breastfeeding mother-infant pairs. J Clin Psychopharmacol. 1998 Abstract
  35. Suri RA, Altshuler LL, Burt VK, Hendrick VC. Managing psychiatric medications in the breast-feeding woman. Medscape Womens Health. 1998 Abstract
  36. Ito S, Blajchman A, Stephenson M, Eliopoulos C, Koren G. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993 May;168(5):1393-9. Abstract
  37. Merlob P, Mor N, Litwin A. Transient hepatic dysfunction in an infant of an epileptic mother treated with carbamazepine during pregnancy and breastfeeding. Ann Pharmacother. 1992 Abstract
  38. Frey B, Schubiger G, Musy JP. Transient cholestatic hepatitis in a neonate associated with carbamazepine exposure during pregnancy and breast-feeding. Eur J Pediatr. 1990 Abstract
  39. Meyer FP, Quednow B, Potrafki A, Walther H. [Pharmacokinetics of anticonvulsants in the perinatal period]. Zentralbl Gynakol. 1988 Abstract
  40. Knott C, Reynolds F, Clayden G. Infantile spasms on weaning from breast milk containing anticonvulsants. Lancet. 1987 Abstract
  41. Froescher W, Eichelbaum M, Niesen M, Dietrich K, Rausch P. Carbamazepine levels in breast milk. Ther Drug Monit. 1984 Abstract
  42. Kuhnz W, Jäger-Roman E, Rating D, Deichl A, Kunze J, Helge H, Nau H. Carbamazepine and carbamazepine-10,11- epoxide during pregnancy and postnatal period in epileptic mother and their nursed infants: pharmacokinetics and clinical effects. Pediatr Pharmacol (New York). 1983 Abstract
  43. Nau H, Kuhnz W, Egger HJ, Rating D, Helge H. Anticonvulsants during pregnancy and lactation. Transplacental, maternal and neonatal pharmacokinetics. Clin Pharmacokinet. 1982 Abstract
  44. Niebyl JR, Blake DA, Freeman JM, Luff RD. Carbamazepine levels in pregnancy and lactation. Obstet Gynecol. 1979 Abstract
  45. Kaneko S, Sato T, Suzuki K. The levels of anticonvulsants in breast milk. Br J Clin Pharmacol. 1979 Abstract Full text (link to original source) Full text (in our servers)
  46. Pynnönen S, Kanto J, Sillanpää M, Erkkola R. Carbamazepine: placental transport, tissue concentrations in foetus and newborn, and level in milk. Acta Pharmacol Toxicol (Copenh). 1977 Abstract
  47. Pynnönen S, Sillanpää M. Letter: Carbamazepine and mother's milk. Lancet. 1975 Abstract

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