Liporace Joyce, Kao Amy, D'Abreu Anelyssa
Department of Neurology, Jefferson Medical College, Philadelphia, PA, USA.
Epilepsy Behav. 2004 Feb;5(1):102-5. doi: 10.1016/j.yebeh.2003.11.018.
Many women with epilepsy who are planning a pregnancy are treated with lamotrigine (LTG), resulting in greater fetal exposure to the drug. Current care guidelines suggest that mothers with epilepsy breast-feed their children. These recommendations are made without regard to how nursing newborns metabolize medication. Lamotrigine is extensively metabolized by glucuronidation, which is immature in neonates and may lead to accumulation of medication. This article reports LTG levels in full-term nursing newborns born to mothers with epilepsy on lamotrigine monotherapy.
Serum LTG levels were obtained in nursing mothers and their neonates on Day 10 of life. Maternal LTG clearance during pregnancy and postpartum was determined and correlated with levels.
Four mothers with partial epilepsy on LTG monotherapy were evaluated. Serum LTG levels in nursing newborns ranged from <1.0 to 2.0 microg/mL on Day 10 of life. Three babies had LTG levels >1.0 microg/mL. After excluding one child with an undetectable level, the LTG levels in newborns were on average 30% (range 20-43%) of the maternal drug level. No decline was noted in two children with repeat levels at 2 months.
Serum concentrations of LTG in breast-fed children were higher than expected, in some cases reaching "therapeutic" ranges. These high levels may be explained by poor neonatal drug elimination due to inefficient glucuronidation. Our observation that not all newborns had a high LTG level suggests considerable genetic variability in metabolism. Our limited data suggest monitoring blood levels in nursing children and the need for individual counseling for women with epilepsy regarding breast-feeding.
许多计划怀孕的癫痫女性使用拉莫三嗪（LTG）进行治疗，这导致胎儿更多地接触该药物。当前的护理指南建议癫痫母亲对孩子进行母乳喂养。这些建议并未考虑哺乳新生儿如何代谢药物。拉莫三嗪通过葡萄糖醛酸化广泛代谢，而新生儿的这种代谢过程不成熟，可能导致药物蓄积。本文报告了接受拉莫三嗪单药治疗的癫痫母亲所生足月哺乳新生儿的LTG水平。
在出生第10天采集哺乳母亲及其新生儿的血清LTG水平。测定孕期和产后母亲的LTG清除率，并将其与水平进行关联。
评估了4名接受拉莫三嗪单药治疗的部分性癫痫母亲。出生第10天，哺乳新生儿的血清LTG水平范围为<1.0至2.0微克/毫升。3名婴儿的LTG水平>1.0微克/毫升。排除1名水平检测不到的儿童后，新生儿的LTG水平平均为母亲药物水平的30%（范围20 - 43%）。2名2个月时复测的儿童未发现水平下降。
母乳喂养儿童的血清LTG浓度高于预期，在某些情况下达到“治疗”范围。这些高水平可能是由于葡萄糖醛酸化效率低下导致新生儿药物清除不佳所致。我们观察到并非所有新生儿的LTG水平都高，这表明代谢存在相当大的遗传变异性。我们有限的数据表明需要监测哺乳儿童的血药水平，以及需要针对癫痫女性进行母乳喂养的个体化咨询。
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