Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, Lyon, France.
Service de neurologie fonctionnelle et épileptologie, hôpital neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.
Fundam Clin Pharmacol. 2024 Jun;38(3):575-578. doi: 10.1111/fcp.12971. Epub 2023 Dec 6.
Lacosamide, a voltage-gated sodium channel inhibitor, is an anti-seizure medication (ASM) from the age of 4. We report on the case of a woman treated with lacosamide for pharmacoresistant epilepsy who breastfed her infant for more than 6 months after birth. The infant's blood concentrations of lacosamide were 2.4 mg/L on Day 1 and less than 1 mg/L on Day 10 (reference values are 1-10 mg/L). No adverse drug reactions (ADRs) were reported for the infant. Eight cases of breastfeeding by mothers receiving lacosamide are described in the literature. These data confirm that a significant amount of lacosamide seems to pass into breast milk, with a relative infant dose (RID) above 20% in two cases but a low RID (1.8%) in another case. Nevertheless, blood tests, performed in two breastfed infants, revealed low concentrations of lacosamide. No ADRs were reported in eight of the breastfed infants; however, one infant, whose mother was also treated with levetiracetam, presented poor feeding and sleepiness at Day 15 of life. Given the well-known benefits of breastfeeding for both mothers and their infants, as well as the above reassuring data, breastfeeding of healthy full-term infants could be possible for mothers on lacosamide monotherapy. Nonetheless, relatives should be warned that data concerning the safety of lacosamide during breastfeeding are scarce and that long-term neurodevelopment outcomes in breastfed children are unknown. Clinical monitoring of breastfed infants for drowsiness, adequate weight gain, or cutaneous rash is recommended. Additionally, the infants' serum levels should be measured in case of an unexplained adverse reaction.
拉科酰胺是一种电压门控钠离子通道抑制剂，是一种用于 4 岁及以上人群的抗癫痫药物（ASM）。我们报告了一例使用拉科酰胺治疗耐药性癫痫的女性，她在分娩后超过 6 个月给婴儿母乳喂养。婴儿在第 1 天的拉科酰胺血药浓度为 2.4mg/L，第 10 天的血药浓度小于 1mg/L（参考值为 1-10mg/L）。婴儿未报告出现药物不良反应（ADR）。文献中描述了 8 例哺乳期母亲接受拉科酰胺治疗的情况。这些数据证实，拉科酰胺似乎有相当大的量进入母乳，在 2 例中相对婴儿剂量（RID）超过 20%，但在另 1 例中 RID 较低（1.8%）。然而，在 2 例母乳喂养的婴儿中进行的血液检测显示拉科酰胺浓度较低。8 例母乳喂养的婴儿中未报告 ADR；然而，其中 1 例婴儿在出生后第 15 天出现喂养不良和嗜睡，其母亲也接受左乙拉西坦治疗。鉴于母乳喂养对母亲及其婴儿的诸多益处，以及上述令人安心的数据，拉科酰胺单药治疗的母亲可以对健康足月婴儿进行母乳喂养。尽管如此，仍应告诫亲属，有关拉科酰胺在母乳喂养期间安全性的数据稀缺，并且母乳喂养儿童的长期神经发育结局尚不清楚。建议对母乳喂养的婴儿进行临床监测，以观察其是否出现嗜睡、体重增加不足或皮疹。此外，如果出现不明原因的不良反应，建议测量婴儿的血清水平。
