Topiramate

Anticonvulsant used in the treatment of epilepsy and migraine prophylaxis. It is also used as an adjuvant in the treatment of obesity. Oral administration.

It is excreted in milk in moderate amounts; the infant may receive slightly more than 10% of the maternal weight-adjusted dose. ^{(Westergren 2014, Fröscher 2006, Öhman 2002)}

Plasma levels in infants whose mothers took topiramate were undetectable or well below (<1 mg/L) the recommended therapeutic level (5 - 20 mg/L) and below 20% of maternal plasma levels ^{(Birnbaum 2020, Fröscher 2006, Öhman 2002)}. In some cases it has been 2.2 mg/L and has been 50% of maternal levels. ^{(Kacirova 2021)}

No clinical or psychomotor developmental problems have been observed in infants whose mothers took it daily for months or years while breastfeeding ^{(Gentile 2009, Fröscher 2006, Johannessen 2005, Öhman 2002)}, except possibly one case of gastroenteritis that subsided when maternal medication was discontinued. ^{(Westergren 2014)}

Expert authors consider it safe during breastfeeding. Watch for the development of diarrhoea, irritability or drowsiness in the infant. ^{(Crettenand 2018, Davanzo 2014 & 2013, Reimers 2014, Rowe 2013)}

See below the information of these related products:

• Maternal Epilepsy (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
• Migraine (Safe product and/or breastfeeding is the best option.)