[Black Orchid]

Hi everyone...

I am a bipolar mom to a 3.5 mo and an (almost) 3 yo. Both are nurslings. Anyway, I have been having major cycling problems with my bipolar depression and am currently weaning myself off Lexipro which I was able to take while pregnant and nursing. The next step is to begin more heavy-duty drug therapy because nothing else is working. Trust me when I say that I've tried everyhitng... different diets, combination of anti depressants, doing nothing...

Does anyone know about lamictal and nursing? I have the 2006 revision of MMM by Dr. Hale, but it doesn't really address the side effects stated by the manufacturer... just gives the expected transfer rate and that in the few cases he's seen that there hasn't been any problems in infants.

Does anyone here have access to any more detailed info? I really, really, really do not want to wean my 3.5 month old. I worked so hard to nurse my older dd and was planning to clw both. I am committed to nursing, but without any further info, showing the safety of nuring on this drug I'm going to have to wean her. I don't feel safe with the info that I've found. Please, please, please help me!

Thanks.

 

[Alana]

I believe its considered a class C..which means they really dont know. I think last I read that the rates of crossover into bm is 20-30%, someone correct me if Im wrong. The biggest side effect with Lamictal is a rash...that can be very serious...and happens mostly in children. I was nursing my 2.5yo when I started taking Lamictal...my Dr said for me to please wean when I hit 50mg. After doing lots of my own research, I decided to do that. But, I do know some women do continue to nurse on it. Sorry Im not more helpful, or have anything more positive to say.

 

[kimkabob5]

I weaned my eight month old when I went on Lamictal and Abilify. It was mostly the Abilify I was uncomfortable with. I think i would have nursed on just Lamictal, but I don't really remember what I read about it. Sorry I'm not much help.

 

[Black Orchid]

Thanks for your replies. The info I've read has the transfer rate at 25-33%, which is really high. MY psychiatrist and I did some reading and found information that stated Lamictal can inhibit folic acid absorbtion and neural tube development. This doesn't end with birth and it scares me to think I might be poisoning DDs with it.

I'm trying to hold off on weaning DD2 completely until she will be 6 months old. I've also been pumping like mad to help offset the ABM she'll have.

This is such a major bummer. I love nursing them so much and it makes me sad to have to stop.

 

[perl]

I'm so sorry mama. I don't know if it helps to think about how having a happy and healthy mama will be soooo beneficial in the long run. Keep on taking good care of yourself and your little ones!

 

[Alana]

Im sorry. When my Dr suggested I wean, that was the point I broke down. I was ok getting the diagnosis, and going on meds....but that was the straw that broke the camel's back, so to speak.
I agree with what the pp said too.

 

[Black Orchid]

Thank you so much for the hugs. It helps to read them. This is seriously one of the hardest things I have ever had to do. For my DD1, she had so many problems and I EP'ed for her for a long time before she finally latched. Nursing was never pleasant because she had a high pallet and reflux, but we worked through it. DD2 is such a great, efficient nurser. It is hard to let go. I'm gradually replacing each nursing for the baby with a bottle and gradually going from EBM to ABM. I'm hoping that a miracle will happen once the Lexipro is out of my system and I'll feel better... or I'll feel better about taking the meds and weaning.

Thanks again. I KNEW that I could find support here. IRL people are like... well Formual is fine... blah,blah,blah and while I know it is fine and this is what it exists for... it still makes me sad.

Thank you for your support

 

[happymum2kyle&keni]

I just found your post after searching online about Lamictal and breastfeeding. I am also a BP mother and am 38 weeks pregnant with my 2nd child. I inquired today from my psychiatrist about being able to breastfeed seeing that I'm only on Lamictal. I take 400mg daily and have since the beginning of my pregnancy. I was first told that Lamictal is the safest mood stabilizer to be on while pregnant. They have new research out that I was able to obtain from him to prove that. Anyhow I didn't see mentioned anything about pregnancy and that is why I asked him today.

He basically said that breastfeeding you will still have some of the Lamictal expressed in your milk but not nearly the levels that you pass onto your baby while being pregnant. So I'm trying to do more research and here are some of the things I have found. Have you had any more success researching this b/c I sure would love to breastfeed this baby or at least do a little breastfeeding and supplementation.

http://experts.about.com/q/Breastfee...eding-meds.htm
http://www.epilepsyfoundation.org/pr...lyplanning.cfm (scroll down to the bottom there is a question about Lamictal and breastfeeding)

I would really like to know your comments and thoughts b/c I would really like the chance to breastfeed this child and seeing as though my Dr said its ok, I'm still a little skeptical. I have not yet asked a ped what he thought of it have you??

Thanks,
Helen

 

[happymum2kyle&keni]

One more site I found as well which is more recent than the others posted.

http://www.epilepsyfoundation.org/pr...ncyask2005.cfm

(scroll to the very last question found on the page)

 

[snowbird25ca]

I'm BP as well and was on lamictal throughout my entire pregnancy with dd & she was ebf for 6 months and then self weaned at 22 months when my milk dried up from this pregnancy. My current dose is 350mg a day... this baby will be bf as well when he is born.

These are the things I considered when researching - granted this was over 2 yrs ago now so I might be a bit foggy on some of the details... but here goes...

1. I looked at my dose and I calculated the RID (relative infant dose,) based on the info in Thomas Hale's book. BTW - I truly consider him the best source of info when it comes to the safety of medication and bf'ing. He is very pro bf'ing but will tell you if he has concerns about a drug.

2. There is some research info out there from when lamictal was being licensed & it was tested in children aged 2 & up. This is the info I don't recall exactly & I don't have time to look it up right now, but it gave a mg/kg dose that they used when testing it in the pediatric population and what range it had to be in to be considered therapeutic.

3. Steven's Johnson Syndrome is a rare side effect of lamictal & it's true that it does affect children more often than adults... however, starting at a very low dose with very slow dosage increases has been shown to decrease the incidence of developing SJS.

4. I know this doesn't apply to the OP, but if you're on it when pregnant, your baby is getting more lamictal in utero than he/she will get when bf'ing.

So in my case, when I did the calculations, my dd wasn't getting anywhere near a clinical dose when you look at the mg/kg ratio. I still monitored her closely the first few weeks after birth to make sure she didn't develop any strange rashes, but she had no problems.

Also, in regards to the folic acid - that concern is speculated to be more in regards to moms who take lamictal while pregnant... although the most recent #'s I have seen have shown that woman who do not have epilepsy and don't take lamictal at the same time as depakote do not have any higher risk of having a baby with spina bifida or other neural tube defects. These disorders are one's that develop in the 1st trimester, so this wouldn't be a concern with a 6 month old nursling.

Good luck with the decision... I know for me I did all the research before I got pregnant with dd and then again right before I delivered. Dd's dr. never had a problem with my meds - I was also on Paxil when I delivered...

But anyways, once I looked at the actual therapeutic dose ranges and realized that my dd wouldn't be getting within that range, I relaxed a lot.

Feel free to PM me if you have other questions, for me Lamictal has been an absolute life saver... it really helped me turn my life around and I've been on it for 6 yrs now. If you'd like I can also try & drum up the exact links that I used before. I know the info I got from the pediatric testing in clincical trials came from one of the technical write-ups that described the licensing process & groups of study population, effectiveness, etc.

 

[snowbird25ca]

I've just today put together a word document that highlights the most relevant points of lamictal's prescribing information. Here is the website with the entire pdf file:

http://us.gsk.com/products/assets/us...information%22

If you'd like the abbreviated version, feel free to PM me with your email and I'll send you a copy of the word document.

The word document I put together cuts it down to a more manageable 6 pages from the 57 on the website...lol. And I've added a few notes of my own about things to consider when making the decision.

 

[snowbird25ca]

This is also a very useful site, it is a q & a forum run by Thomas W. Hale - the author of Medications and Mother's Milk. Only health professionals can post questions, but everyone is able to read the messages.

Here's the main index for all categories of medication:

http://neonatal.ama.ttuhsc.edu/cgi-b...s&access=guest

And here's a thread link in relation to lamictal:

http://66.230.33.248/discus/messages...tml?1091371393

I've bookmarked his website since I find it useful as a quick reference for antidepressants and other meds that are sometimes discussed.

 

[happymum2kyle&keni]

Trudy,

Thanks again for the info, I did get a chance to go to B&N and look at that book. It has helped me make my decision that I will breastfeed and supplement. Hale does a wonderful job and his site is helpful as well.

Thanks again,

Helen

 

[Black Orchid]

OMG, Trudy... thank you so much! This is all info that I have not seen! I have access to Thomas Hale's online DB and that and the drug insert was all that I had seen...

Thank you THANKYOU THANK YOU!!!!!!!!!!!!!

 

[snowbird25ca]

Glad I could help.

I'm a bit fanatical when it comes to researching stuff like this.