Lamotrigine Use in Lactating Women: Passage into Breast Milk and Infant Exposure: Grand Round/A Case Study.

IF 2.8 4区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Therapeutic Drug Monitoring Pub Date : 2024-12-17 DOI:10.1097/FTD.0000000000001299
Daphne den Besten-Bertholee, Ilse Wegner, Daan J Touw, Peter G J Horst, Paola Mian
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Abstract

Background: Lamotrigine, an antiseizure medication used for epilepsy and bipolar disorders, is often prescribed to women of childbearing age due to relatively low teratogenic risk. It is known that lamotrigine use in lactation leads to detectable concentrations in breast milk, although concentrations vary significantly among individuals.

Case presentation: A 35-year-old pregnant woman with epilepsy presented to our outpatient clinic. She was seizure-free and was taking lamotrigine 200 mg once daily. She is highly motivated to breastfeed her baby after birth but is concerned about the infant's exposure to lamotrigine through lactation. Lamotrigine concentrations were measured in both the breast milk and plasma of the suckling infants.

Conclusions: Although lamotrigine is excreted into breast milk, and detectable in infants, the benefits of breastfeeding should not be overlooked. Higher plasma concentrations generally lead to higher breast milk concentrations, so aiming for the lowest possible maternal plasma levels is beneficial. These findings underscore the importance of TDM in this population.

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拉莫三嗪在哺乳期妇女中的使用:进入母乳和婴儿暴露:Grand Round/A案例研究。
背景:拉莫三嗪是一种用于治疗癫痫和躁郁症的抗癫痫药物,由于其致畸风险相对较低,因此常被开给育龄妇女。据了解,哺乳期服用拉莫三嗪会导致母乳中检测到浓度,但不同个体的浓度差异很大:一名 35 岁的癫痫孕妇来到我们的门诊就诊。她没有癫痫发作,每天服用一次拉莫三嗪,每次 200 毫克。她非常希望在婴儿出生后用母乳喂养,但担心婴儿在哺乳期会接触到拉莫三嗪。在哺乳婴儿的母乳和血浆中均检测到了拉莫三嗪的浓度:尽管拉莫三嗪会排泄到母乳中并在婴儿体内检测到,但母乳喂养的益处不容忽视。较高的血浆浓度通常会导致较高的母乳浓度,因此尽可能降低母体血浆浓度是有益的。这些发现强调了 TDM 在这一人群中的重要性。
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来源期刊
Therapeutic Drug Monitoring
Therapeutic Drug Monitoring 医学-毒理学
CiteScore
5.00
自引率
8.00%
发文量
213
审稿时长
4-8 weeks
期刊介绍: Therapeutic Drug Monitoring is a peer-reviewed, multidisciplinary journal directed to an audience of pharmacologists, clinical chemists, laboratorians, pharmacists, drug researchers and toxicologists. It fosters the exchange of knowledge among the various disciplines–clinical pharmacology, pathology, toxicology, analytical chemistry–that share a common interest in Therapeutic Drug Monitoring. The journal presents studies detailing the various factors that affect the rate and extent drugs are absorbed, metabolized, and excreted. Regular features include review articles on specific classes of drugs, original articles, case reports, technical notes, and continuing education articles.
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