Related Experiment Videos
Phenobarbital in Sera of Epileptic Mothers and Their Infants
Yutaka Gomita1, Katsushi Furuno, Yasunori Araki
1Department of Hospital Pharmacy, Okayama University Medical School, Okayama, Japan.
Insights
Phenobarbital (PB) transfer to breast milk is higher in mothers taking multiple antiepileptic drugs (polypharmacy) versus a single drug (monopharmacy). Offspring PB levels are also elevated with polypharmacy, especially early postpartum.
Area of Science:
- Pharmacology
- Neonatal Studies
- Epilepsy Management
Background:
- Epileptic mothers often require antiepileptic drugs (AEDs) during pregnancy and lactation.
- Phenobarbital (PB) is a commonly used AED, and its transfer into breast milk is a concern for nursing infants.
Purpose of the Study:
- To investigate the pharmacokinetics of phenobarbital (PB) transfer from epileptic mothers to their breast milk and offspring.
- To compare PB concentrations in monopharmacy versus polypharmacy (PB with other AEDs) in mothers and their infants.
Main Methods:
- Studied 26 epileptic mothers and 24 of their breastfed offspring.
- Measured maternal serum PB concentrations at various postpartum stages (0-5 days, 6-10 days, 1-2 months, 3-5 months).
- Measured PB concentrations in breast milk and offspring serum.
Main Results:
- Maternal serum PB levels were similar in monopharmacy across stages, but higher in polypharmacy.
- Breast milk PB concentrations were significantly higher in polypharmacy only in the early postpartum stage (0-5 days).
- Offspring PB concentrations were markedly higher in polypharmacy compared to monopharmacy, particularly in the early postpartum period.
Conclusions:
- Phenobarbital pharmacokinetics differ significantly between monopharmacy and polypharmacy in the perinatal period.
- Polypharmacy with AEDs increases PB exposure in both mothers and breastfed infants.
- These findings highlight the importance of considering drug regimen when assessing risks of AEDs in breastfeeding epileptic mothers.
Abstract:
The phenobarbital (PB) transition from epiletpic mothers to their breast milks and offspring in cases of PB monopharmacy with other antiepileptic drugs was investigated in 26 epileptic mothers and 24 offspring who were taking the breast milk from epileptic mothers. The mother's serum PB concentration in monopharmacy was almost the same in various stages (stage I, with 5 days after the delivery; stage II, 6--10 days after; stage III, 1--2 mothers after; stage IV, 3--5 months after). However, the PB concentrations in polypharmacy were markedly higher than those in monopharmacy. Concerning the PB concentration in breast milk, a significant increase was found in polypharmacy in comparison with monopharmacy only in stage I. On the other hand, the offspring's PB concentration in polypharmacy was markedly higher than that in monopharmacy, particularly in stage I. In another stages, PB concentration in monopharmacy gradually decreased according to the increase of stages. These results indicate that pharmacokinetics of antiepileptic drugs in the perinatal may be considerably different in PB monopharmacy and polypharmacy.