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Keppra®
 

Pregnancy and Keppra

The U.S. Food and Drug Administration (FDA) lists Keppra in Pregnancy Category C. This indicates that caution is advised, but the benefits of the medication may outweigh the potential risks. Studies in animals have shown some harm to the fetus. There have been no published reports of pregnancy outcomes in Keppra-treated women.

The risk of defects is generally higher for women who take more than one AED and for women with a family history of birth defects. Advise women who are capable of becoming pregnant to take at least 400 mcg (0.4 mg) of folic acid (folate) daily to help prevent neural tube defects. Women at high risk, such as those with a history of a neural tube defect in a previous pregnancy, should take 4000 mcg (4 mg) daily, beginning before they become pregnant. The effectiveness of prophylactic folic acid use in preventing defects related to Keppra has not been proven, however, so diagnostic ultrasonography at the 18th to 20th week is recommended, especially if pregnancy termination is an option.

About 20% to 35% of women have seizures more often during pregnancy because of changes in hormones or changes in how their AED is handled by the body. Whether this applies to Keppra is not yet known, so blood levels during pregnancy may help determine if the dosage needs to be adjusted.

Keppra is excreted in breast milk. According to the package insert, because of the potential for serious adverse reactions in nursing infants from Keppra, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.