Valproate Pivoxil

Drug used in the treatment of various forms of epilepsy, in the manic phase of bipolar disorder and in the prophylaxis of migraine. Twice daily oral administration. Possible intravenous administration.

It is excreted in human milk in a clinically non-significant amount. ^{(Abstract 238-240 2011, Meyer 1988, Tsuru 1988, Philbert 1985, von Unruh 1984, Nau 1981, Alexander 1979, Dickinson 1979)}

Neither short-term nor long-term growth nor cognitive development problems have been observed in infants whose mothers took it. ^{(Aydin 2015, Meador 2014, Mintzer 2011, Johannessen 2005, Piontek 2000, Wisner 1998, Philbert 1985, Alexander 1979)}

The plasma levels of these infants were very low or below the detection limit. ^{(Abstract 238-240 2011, Piontek 2000, Birnbaum 1999, Wisner 1998, Philbert 1985, Alexander 1979).}

One infant developed thrombopenic purpura and anemia that recovered when the mother was withdrawn from valproate ^{(Stahl 1997)}, but there were doubts as to whether it was post-viral idiopathic thrombopenic purpura.

A 4-month-old infant whose mother was taking valproate developed alopecia that disappeared when the mother discontinued the medication. ^{(Govindan 2021)}

Administration of valproic acid does not affect prolactin levels. ^{(Hering 1992)}

Various medical societies and expert consensus consider it generally safe to use this medication during breastfeeding. ^{(LacMed, Uguz 2021, Crettenand 2018, Grover 2015, Davanzo 2014 and 2013, Rowe 2013, Veiby 2013, Pringsheim 2012, Mercadé 2012, O'Connor 2009, Harden 2009, Sharma 2009, Stowe 2007, Pennell 2006, Pack 2006, Even 2006, Tomson 2005, O'Brien 2005, Rubin 2004, Hägg 2000, Bar-Oz 2000, Austin 1998)}

American Academy of Pediatrics: medication usually compatible with breastfeeding. ^{(AAP 2001)}

WHO 2002 List of Essential Medicines: compatible with breastfeeding. ^{(WHO/UNICEF 2002)}