Serum valproate levels in 6 breastfeeding mother-infant pairs.
BACKGROUND
Women with bipolar disorder are at high risk for recurrence of an affective episode in the postpartum period, and treatment with a mood stabilizer may be indicated. Few data are available to inform the risk-benefit decision regarding the use of valproate for women with bipolar disorder who elect to breast-feed.


METHODS
Serum valproate levels were obtained from 6 breastfeeding mother-infant pairs. All mothers had a diagnosis of bipolar disorder (Research Diagnostic Criteria) and were taking divalproex sodium as prophylaxis for or treatment of a recurrent affective episode. None of the mothers received valproate during pregnancy.


RESULTS
The mothers had serum valproate levels near or within the therapeutic range (39.4 to 79.0 microg/mL). Infant serum levels were low, ranging from 0.7 to 1.5 microg/mL (0.9%-2.3% of maternal serum levels). No adverse clinical effects were observed in the infants.


CONCLUSIONS
Serum valproate levels were low in nurslings of mothers treated with valproate. These data can be used to inform clinical decisions regarding the use of valproate during breastfeeding.
Piontek
C M
CM
Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio 44106, USA.
Baab
S
S
Peindl
K S
KS
Wisner
K L
KL
D000367:Age Factors; D000818:Animals; D001714:Bipolar Disorder / Q000097:blood / Q000188:drug therapy*; D001942:Breast Feeding; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn / Q000097:blood; D049590:Postpartum Period / Q000097:blood*; D011247:Pregnancy; D011644:Puerperal Disorders / Q000097:blood / Q000188:drug therapy*; D055502:Secondary Prevention; D014635:Valproic Acid / Q000097:blood* / Q000627:therapeutic use
D014635:Valproic Acid