Infants topiramate

Lactation Topiramate is excreted in the milk of lactating rats. Limited observations in patients suggest an extensive secretion of topiramate into breast milk. Weigh the potential benefit to the mother against the potential risk to the infant. 

Hypospadia has occurred in some male infants whose mothers took topiramate during pregnancy... 

The concentrations of topiramate have been measured in plasma and breast milk in five women with epilepsy during pregnancy and lactation (52). The umbilical cord plasma/maternal plasma ratios were close to unity, suggesting extensive transplacental transfer of topiramate. The mean milk/maternal plasma concentration ratio was 0.86 (range 0.67-1.1) at 2-3 weeks after delivery. The milk/maternal plasma concentration ratios at sampling 1 and 3 months after delivery were similar. Two of the breast-fed infants had detectable (>0.9 pmol/l) concentrations of topiramate 2-3 weeks after delivery, although they were below the limit of quantification (2.8 pmol/l), and one had an undetectable concentration. Thus, breastfed infants had very low topiramate concentrations. No adverse effects were observed in the infants. 

Philippi H, Boor R, Reitter B. Topiramate and metabohc acidosis in infants and toddlers. Epilepsia 2002 43(7) 744—7. 

Novotny E, Renfroe B, Yardi N, Nordli D, Ness S, Wang S, Weber T, Kurland CL, Yuen E, Eerdekens M, Venkatraman L, Nye IS, Ford L. Randomized trial of adjunctive topiramate therapy in infants with refractory partial seizures. Neurology 2010 74(9) 714-20. 

Observational studies In a long-term, open, observational study, the long-term retention rate and adverse effects of carbamazepine ( = 105) were evaluated and compared with topiramate ( = 41) in infants and toddlers with epilepsy [72 ]. After 6 months, 73% of those who had been treated with topiramate and 63% of those who had been treated with carbamazepine were improved. Topiramate was withdrawn because of adverse effects in only one case (2.4%), whereas carbamazepine was withdrawn because of adverse effects in 6.7% of patients. 

The long-term effects of topiramate on adaptive behavior in infants with epilepsy were assessed [161 ]. A clinically significant decline in scores on the Vineland Scales of Adaptive Behavior occurred in infants treated with topiramate. Of note, however, Vineland scores were below average at pretreatment baseline in these patients. Anorexia was noted in 35% of patients and somnolence in 27%. 

Ness S, Todd MJ, Wang S, Eerdekens M, Nye JS, Ford L. Adaptive behavior outcomes in infants treated with adjunctive topiramate. Pediatr Neurol June 2012 46(6) 350-8. 

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