Phenobarbital and breastfeeding

I am thirty one weeks pregnant with our first child. I have epilepsy and have to take phenobarbital to prevent seizures. Every doctor that I have asked is unable to give my husband and I an answer on whether it is safe to breastfeed while taking this medication. Is phenobarbital safe while nursing, and is there any way of finding out how much of this drug is in my milk?

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Debbi Donovan

Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more

Phenobarbital is a sedative and anticonvulsant. Since you have been treated with this drug during your pregnancy, breastfeeding may actually help your newborn to gradually withdraw from the medication he has received in utero, without experiencing negative side effects. (Bossi L: Neonatalperiod including drug disposition in newborns: review of the literature: Epilepsy, pregnancy, and the child, 1982)

Phenobarbital is excreted into breastmilk and because it is long acting, your baby will need to be watched for drowsiness. The average amount of phenobarbital taken in by a nursing infant is estimated to be between 2 and 4 mg. per day. A physician should regularly monitor your baby's phenobarbital level. If your baby shows signs of sedation, supplementation of around two to three ounces, one or two times each day, can reduce the negative effect of the medication (Brodie MJ: Management of epilepsy during pregnancy andlactation, Lancet 336:426, 1990).

Cup feeding can be used for supplementation, even with premature babies. Artificial nipples should be avoided in the early weeks. They may lead to suck confusion, resulting in early termination of the breastfeeding relationship.

You might want to ask your physician if there are shorter acting medications available that could be safely substituted for the phenobarbital. Shorter acting drugs cause less accumulation in the infant.

If your baby is very sleepy in the first few days of life, he will need to be carefully monitored. If he is not nursing well it is important to immediately begin using a hospital-grade electric breastpump as often as he would nurse -- about every two hours. He should be fed your expressed milk, preferably by cup. Within a few days he should be more alert and be better able to breastfeed effectively.

I would recommend working with a Lactation Consultant in your area. To locate an IBCLC (International Board Certified Lactation Consultant) you can contact the ILCA (International Lactation Consultant Association) office. You will be referred to three IBCLC's in your area. You can reach them at:

ILCA
200 N. Michigan Ave, Suite 300
Chicago IL, 60601
phone 312-541-1710
fax 312-541-1271
email ilca@erols.com

Hoping this information will help you to make the best choice for you and your family.

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