Cabo-Lopez I, Canneti B, Puy-Nunez A
Complejo Hospitalario de Pontevedra, 36001 Pontevedra, Espana.
Rev Neurol. 2019 Jul 16;69(2):68-76. doi: 10.33588/rn.6902.2019037.
In clinical practice, it is common to find cases of epileptic women being treated with antiepileptic drugs (AEDs) whom we have to advise on the compatibility of these AEDs with breastfeeding.
In order to offer correct guidance, we must be well informed about the pharmacokinetic characteristics of the different AEDs, in addition to being aware of the clinical experience in this regard. This review stems from the paucity of information on this topic.
The World Health Organisation recommends that breastfeeding should be the norm for all women, even in epileptic mothers that are taking AEDs, who must always be given special attention in order to watch for the appearance of adverse effects in the infant, and always avoiding sudden weaning in order to avoid withdrawal symptoms.
Very few AEDs are incompatible with breastfeeding. The decision to breastfeed should take into account not only the AED, but also its number, dose, serum levels, transmission and elimination rates in the infant, and the conditions of the newborn infant. Ethosuximide and felbamate are probably high risk and incompatible with breastfeeding. Lamotrigine, phenobarbital, pregabalin, primidone, tiagabine, eslicarbazepine, brivaracetam, perampanel, zonisamide, lacosamide or the sporadic use of benzodiazepines in low doses are considered quite safe, with a low risk for breastfeeding. The other AEDs present a very low risk for breastfeeding.
在临床实践中，经常会遇到癫痫女性患者正在接受抗癫痫药物（AEDs）治疗的情况，我们必须就这些抗癫痫药物与母乳喂养的兼容性向她们提供建议。
为了提供正确的指导，我们除了要了解不同抗癫痫药物的药代动力学特征外，还必须知晓这方面的临床经验。本综述源于该主题信息的匮乏。
世界卫生组织建议，母乳喂养应是所有女性的常态，即使是正在服用抗癫痫药物的癫痫母亲也不例外，必须始终给予她们特别关注，以留意婴儿是否出现不良反应，并且始终避免突然断奶以防止戒断症状。
极少有抗癫痫药物与母乳喂养不相容。是否进行母乳喂养的决定不仅应考虑抗癫痫药物，还应考虑其种类、剂量、血清水平、在婴儿体内的转运和消除速率以及新生儿的状况。乙琥胺和非氨酯可能具有高风险且与母乳喂养不相容。拉莫三嗪、苯巴比妥、普瑞巴林、扑米酮、替加宾、艾司利卡西平、布瓦西坦、吡仑帕奈、唑尼沙胺、拉科酰胺或偶尔低剂量使用苯二氮䓬类药物被认为相当安全，母乳喂养风险较低。其他抗癫痫药物母乳喂养风险极低。
