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Use of Phenytoin, Phenobarbital Carbamazepine, Levetiracetam Lamotrigine and Valproate in Pregnancy and Breastfeeding: Risk of Major Malformations, Dose-dependency, Monotherapy vs Polytherapy, Pharmacokinetics and Clinical Implications

[ Vol. 19 , Issue. 11 ]

Author(s):

Yusuf Cem Kaplan* and Omer Demir   Pages 1805 - 1824 ( 20 )

Abstract:


It is challenging to balance the fetal risks associated with the use of antiepileptic drugs (AEDs) against maternal and fetal risks of seizure worsening, and therefore it is very important to define and distinguish the possible risks entailed by different AEDs. This paper aims to undertake a comprehensive review regarding the possible risks of four classical (phenytoin, carbamazepine, phenobarbital, and valproate) and two newer (lamotrigine and levetiracetam) AEDs during pregnancy. The review focuses on major and organ-specific malformations, dose-dependent risks, mono vs polytherapy, and clinical pharmacokinetics. A discussion regarding the safety of AED use during breastfeeding is also provided.

Keywords:

Pregnancy, breastfeeding, antiepileptics, major malformations, phenytoin, carbamazepine, phenobarbital, valproate, lamotrigine, levetiracetam.

Affiliation:

Terafar - Izmir Katip Celebi University Teratology Information, Training and Research Center, Izmir, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Teratology Information Center, Izmir

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