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Panel: Avoid Epilepsy Drug in Pregnancy

New Guidelines Urge Pregnant Women to Avoid Taking Valproate Because of Risk of Birth Defects

Epilepsy Drugs and Breastfeeding

The epilepsy drugs primidone (Mysoline) and levetiracetam (Keppra) were detected in breast milk at various levels "that may be clinically important," while valproate, phenobarbital, phenytoin, and carbamazepine (Tegretol) were not, the panel says.

"We didn't find much evidence one way or another that any of the drugs caused adverse effects in babies who were breastfed, but this information can help women and their doctors to make decisions about breastfeeding," Harden says.

Women should not stop taking any drug without consulting their physician, Harden stresses.

She suggests that women with epilepsy have a discussion with their doctor about seizure medications at least six months before becoming pregnant.

Valproate is an "excellent drug," and for some women, it may be the only medication that effectively controls their seizures, Gronseth says. "Women and their doctors have to weigh the potential risk of birth defects against the potential risk of uncontrolled seizures."

Valproate Also Used to Treat Migraines

"Luckily, it's not that hard to avoid valproate during pregnancy," as there are now more than a dozen seizure drugs available, says AAN spokesman Joseph Sirven, MD, professor of neurology at the Mayo Clinic in Phoenix.

Sirven points out that many more people, including pregnant women, take valproate to relieve migraine headaches.

"Lower doses are used than for epilepsy, so the drug may not pose the same problems [as when used to treat seizures]," he tells WebMD.

Nonetheless, women who have been prescribed valproate for any reason "should have a frank discussion with their doctors if they are planning to become pregnant," Sirven says.

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