Vigabatrin and Breastfeeding

Summary of use during lactation

Limited information indicates that maternal doses of vigabatrin up to 2000 mg daily produce low levels in milk. Vigabatrin is approved for use in infants in one month and older and amounts in milk are far less than the approved infant dosage. Vigabatrin would not be expected to cause any adverse effects in breastfed infants.

Drug levels in milk and infant serum

Maternal Levels. Two nursing mothers were each receiving vigabatrin 1000 mg twice daily. One was also taking slow-release carbamazepine 200 mg twice daily. Milk samples were collected once predose and 3 and 6 hours after the dose at either 6 or 8 days postpartum. In both mothers, the inactive R-isomer was excreted into milk in higher concentrations than the active S-isomer. In the 2 mothers, average concentrations of the R-isomer were 1.7 mg/L in the predose sample, 2.1 mg/L at 3 hours and 3.1 mg/L at 6 hours after the dose. Average concentrations of the S-isomer were 0.4 mg/L in the predose sample, 0.4 mg/L at 3 hours and 0.8 mg/L at 6 hours after the dose. Using peak values, the authors estimated that the maximum dosage that the infant would receive in the mothers would be 2 to 3.6% of the weight-adjusted maternal dosage for the R-isomer and 0.6 to 0.96% of the maternal dosage for the S-isomer.[1] Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

Relevant published information was not found as of the revision date.

Effects on lactation and breastmilk

Relevant published information was not found as of the revision date.

Alternative drugs to consider

(Seizure Disorder) Carbamazepine, Divalproex, Gabapentin, Lamotrigine, Oxcarbazepine, Phenytoin, Valproic Acid

References

1. TranA O'MahoneyT ReyE Vigabatrin: Placental transfer in vivo and excretion into breast milk of the enantiomers. Br J Clin Pharmacol 1998 45 409 11 9578192 PubMed