Serum Valproate Levels in 6 Breastfeeding Mother-Infant Pairs
J Clin Psychiatry 2000;61(3):170-172
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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.
Method: 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.
Conclusion: 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