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Lamictal and Pregnancy

Bipolar Medications Library - Lamictal

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Updated March 22, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Is Lamictal safe during pregnancy? Is it, or the generic lamotrigine, safe during breast feeding? Does Lamictal cause birth defects? While there is not enough data to answer these questions conclusively, researchers have been able to gather enough information to issue guidelines.

Lamictal During Pregnancy

Thus far, Lamictal has not been shown to cause any significant increases in birth defects overall. Some data shows that there is an increased risk of cleft lip and palate malformations, but other data does not.

The FDA-approved prescribing information says that lamotrigine "should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus." The "potential benefit" is generally the mother's mental health condition. In a 2009 article, Dr. Ruta M. Nonacs points out that many women with bipolar disorder may require a mood stabilizer during pregnancy. The alternatives to Lamictal, she says, may carry an even greater risks. Depakote, for example, carries a 10% risk of birth defects, some very serious, and Topamax carries a strong warning about the risk of cleft lip and palate malformations. Tegretol (carbamazepine), Trileptal (oxcarbazepine) and Lithium are also classed as being more likely than Lamictal to be dangerous to a fetus. Mood stabilizers in the same pregnancy class as Lamictal are:

Lamictal and the other mood stabilizers listed above is in FDA Pregnancy Category C: "Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks." For Lamictal, animal studies did not show a great deal of of danger to fetuses, but there was enough concern to warrant the drug's assignment to Category C.

Lamictal While Breast Feeding

Lamictal does pass into breast milk, and the prescribing information says breast feeding while taking Lamictal or lamotrigine (in any form) is not recommended. However, reports of breast fed infants whose mothers are taking lamotrigine having problems are uncommon.

If you do choose to breast feed your infant while taking Lamictal, your infant should be closely monitored for side effects such as interrupted breathing, rash, drowsiness or poor sucking. If any infant rash occurs, breast feeding should be discontinued until the cause can be established. This is because Lamictal is associated with dangerous rashes. Have the infant's rash evaluated promptly.

References:

Cunnington, M., PhD, Tennis, P., MD, and the International Lamotrigine Pregnancy Registry Scientific Advisory Committee. Lamotrigine and the risk of malformations in pregnancy. Neurology March 22, 2005 vol. 64 no. 6 955-960.

Nonacs, R.M., MD, PhD. Lamotrigine and Pregnancy: An Update. Massachusetts General Hospital Center for Women's Mental Health. August 25, 2009.

Lamotrigine use while Breastfeeding. Drugs.com.

Lamotrigine in pregnancy and breast-feeding. Drug Safety Society.

Lamotrigine - Brands, Medical Use, Clinical Data. DrugLib.com.

FDA Approved Label for Lamictal published October 12, 2010.

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