Dose Adjustment of the Anti-Seizure Medications Levetiracetam and Lamotrigine During the Postpartum Period. Schedule Plan, Safety and Efficacy

Authors

Nadejda Khmelev
Firas Fahoum
Lilach Goldstein, Thomas Jefferson UniversityFollow

Document Type

Article

Publication Date

12-12-2025

Comments

This article is the author’s final published version in Epilepsy and Behavior, Volume 175, 2026, Article number 110858.

The published version is available at https://doi.org/10.1016/j.yebeh.2025.110858. Copyright © 2025 The Authors.

Abstract

INTRODUCTION: Lamotrigine (LTG) and Levetiracetam (LEV) are anti-seizure medications (ASMs) widely used for treatment of women with epilepsy (WWE) of childbearing age due to low teratogenic potential. Physiological changes during gestation results in enhanced clearance. Drug level monitoring and frequent dose adjustments are required to avoid decline in serum levels and compromised seizure control. Postpartum, physiological changes reverse and ASM clearance trends back to pre-pregnancy rate. Rapid metabolic changes make drug level monitoring and dose adjustments challenging. A delay in dose decrement could result in toxicity. The optimal postpartum dose reduction rate hasn't been established.

METHODS: We retrospectively examined medical records of pregnant WWE followed at Tel Aviv Sourasky Medical Center from 2018 to 2023. Initially, patients were instructed to continue therapeutic drug monitoring (TDM) postpartum. Starting October 2020, an empiric taper regimen was implemented with dose adjustments scheduled 1, 7, and 21 days postpartum. Individualized regimens were provided during last prenatal visit. We recorded ASM dose, serum levels, seizure frequency, and side effects.

RESULTS: Eighty-one pregnancies in 75 WWE were included. Forty-two were treated with LEV, 35 with LTG, and 4 with both. In 24 pregnancies patients continued TDM postpartum, and 57 followed empiric protocol. Among seizure-free WWE before and during pregnancy, none of 44 in the empiric group and 2 of 16 in TDM group had postpartum seizures. Side effects occurred in 6 of 54 empiric group and 5 of 21 TDM group.

CONCLUSION: Empiric postpartum tapering was not linked to increased seizure risk and was well tolerated.

Recommended Citation

Khmelev, Nadejda; Fahoum, Firas; and Goldstein, Lilach, "Dose Adjustment of the Anti-Seizure Medications Levetiracetam and Lamotrigine During the Postpartum Period. Schedule Plan, Safety and Efficacy" (2025). Department of Neurology Faculty Papers. Paper 388.
https://jdc.jefferson.edu/neurologyfp/388

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

PubMed ID

41389469

Language

English