The issue of prescription of analgesics during lactation is clinically important but also complex. Most of the information available is based on single dose or short term studies, and for many drugs only a single or a few case reports have been published. As great methodological problems exist in the assessment of possible adverse drug reactions in neonates and infants, there is limited knowledge about the practical impact of the, often very low, concentrations found. Nevertheless, some recommendations can be made.
Breast-feeding during maternal treatment with paracetamol (acetaminophen) should be regarded as being safe. Short term use of nonsteroidal anti-inflammatory drugs seems to be compatible with breast-feeding. For long term treatment, short-acting agents without active metabolites, such as ibuprofen, should possibly be preferred. The use of aspirin (acetylsalicylic acid) in single doses should not pose any significant risks to the suckling infant.
Use of codeine is probably compatible with breast-feeding, although the effects of long term exposure have not been fully elucidated. For propoxyphene, it seems unlikely that the suckling infant will ingest amounts that will cause any detrimental effects during short term treatment. However, it cannot be excluded that significant amounts of the metabolite norpropoxyphene may arise in the suckling infant during long term exposure.
Treatment of the mother with single doses of morphine or pethidine (meperidine) is not expected to cause any risk for the suckling infant. Repeated administration of pethidine, in contrast to morphine, affects the suckling infant negatively. Thus, morphine should be preferred in lactating mothers However, during long term treatment with morphine, the importance of uninterrupted breast-feeding should be assessed on an individual basis against the potential risk of adverse drug effects in the infant. If it is decided to continue breast-feeding the infant should be observed for possible adverse effects.
In general, if treatment of a lactating mother with an analgesic drug is considered necessary, the lowest effective maternal dose should be given. Moreover, infant exposure can be further reduced if breast-feeding is avoided at times of peak drug concentration in milk. As breast milk has considerable nutritional, immunological and other advantages over formula milk, the possible risks to the infant should always, and on an individual basis, be carefully weighed against the benefits of continuing breast-feeding.
Morphine Breast Milk Naproxen Piroxicam Pethidine
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.
Dewey KG, Heinig MJ, Nommsen-Rivers LA. Differences in morbidity between breast-fed and formula-fed infants. J Pediatr 1995; 126: 696–702PubMedCrossRefGoogle Scholar
Wright AL, Holberg CJ, Martinez FD, et al. Breast-feeding and lower respiratory tract illness in the first year of life. BMJ 1989; 299: 946–9PubMedCrossRefGoogle Scholar
Pisacane A, Graziano L, Mazzarella G, et al. Breast-feeding and urinary tract infection. J Pediatr 1992; 120: 87–9PubMedCrossRefGoogle Scholar
Saarinen UM, Kajosaari M, Backman A, et al. Prolonged breastfeeding as prophylaxis for atopic disease. Lancet 1979; II: 163–8CrossRefGoogle Scholar
Hahn-Zoric M, Fulconis F, Minoli I, et al. Antibody responses to parenteral and oral vaccines are impaired by conventional and low protein formulas as compared to breast-feeding. Acta Paediatr Scand 1990; 79: 1137–42PubMedCrossRefGoogle Scholar
Ball TM, Wright AL. Health care costs of formula-feeding in the first year of life. Pediatrics 1999; 103: 870–6PubMedGoogle Scholar
Byers T, Graham S, Rzepka T, et al. Lactation and breast cancer: evidence for a negative association in premenopausal women. Am J Epidemiol 1985; 121: 664–74PubMedCrossRefGoogle Scholar
Spigset O, Hägg S. Excretion of psychotropic drugs into breast milk. CNS Drugs 1998; 9: 111–34CrossRefGoogle Scholar
Miners JO, Birkett DJ. Cytochrome P4502C9: an enzyme of major importance in human drug metabolism. Br J Clin Pharmacol 1998; 45: 525–38PubMedCrossRefGoogle Scholar
Yue QY, Hasselström J, Svensson JO, et al. Pharmacokinetics of codeine and its metabolites in Caucasian healthy volunteers: comparison between extensive and poor metabolisers of debrisoquine. Br J Clin Pharmacol 1991; 31: 635–42PubMedCrossRefGoogle Scholar
Bertilsson L. Geographic/interracial differences in polymorphic drug oxidation. Clin Pharmacokinet 1995; 29: 192–209PubMedCrossRefGoogle Scholar
Casey C, Hambridge KM. Nutritional aspects of human lactation. In: Neville MC, Neifert MR, editors. Lactation: physiology, nutrition and breast-feeding. New York (NY): Plenum Press, 1983: 199–248Google Scholar
Öhman R, Hägg S, Carleborg L, et al. Excretion of paroxetine into breast milk. J Clin Psychiatry 1999; 60: 519–23PubMedCrossRefGoogle Scholar
Prentice A, Prentice AM, Whitehead RG. Breast-milk fat concentrations of rural African women: short-term variations within individuals. Br J Nutr 1981; 45: 483–94PubMedCrossRefGoogle Scholar
Bennett PN. Drugs and human lactation. 2nd ed. Amsterdam: Elsevier, 1996Google Scholar
Wilson JT, Brown DJ, Hinson JL, et al. Pharmacokinetic pitfalls in the estimation of the breast milk/plasma ratio for drugs. Annu Rev Pharmacol Toxicol 1985; 25: 667–89PubMedCrossRefGoogle Scholar
Jamali F, Keshavarz E. Salicylate excretion in breast milk. Int J Pharmacol 1981; 8: 285–90CrossRefGoogle Scholar
Pütter J, Satravaha P, Stockhausen H. Quantitative Bestimmung der Hauptmetaboliten der Acetylsalizylsäure. Vergleichende Bestimmung in Blut und Milch von Stillenden Frauen. Z Geburtshilfe Perinatol 1974; 178: 135–8Google Scholar
Pütter J. Übersicht über die Pharmakokinetik der Acetylsalizylsäure. Med Welt 1976; 27: 1362–5PubMedGoogle Scholar
Feilberg VL, Rosenborg D, Christensen CB, et al. Excretion of morphine in human breast milk. Acta Anaesthesiol Scand 1989; 33: 426–8PubMedCrossRefGoogle Scholar
Wittels B, Scott DT, Sinatra RS. Exogenous opioids in human breast milk and acute neonatal neurobehavior: a preliminary study. Anesthesiology 1990; 73: 864–9PubMedCrossRefGoogle Scholar
Peiker G, Müller B, Ihn W, et al. Ausscheidung von Pethidin durch die Muttermilch. Zbl Gynaekol 1980: 102: 537–41Google Scholar
Quinn PG, Kuhnert BR, Kaine CJ, et al. Measurement of meperidine and normeperidine in human breast milk by selected ion monitoring. Biomed Environ Mass Spectrom 1986; 13: 133–5PubMedCrossRefGoogle Scholar
Borgatta L, Jenny RW, Gruss L, et al. Clinical significance of methohexital, meperidine, and diazepam in breast milk. J Clin Pharmacol 1997; 37: 186–92PubMedGoogle Scholar
Kunka RL, Venkataramanan R, Stern RM, et al. Excretion of propoxyphene and norpropoxyphene in breast milk. Clin Pharmacol Ther 1984; 35: 675–80PubMedCrossRefGoogle Scholar
Kunka RL, Yong C-L, Ladik CF, et al. Liquid chromatographic determination of propoxyphene and norpropoxyphene in plasma and breast milk. J Pharm Sci 1985; 74: 103–4PubMedCrossRefGoogle Scholar
Robieux I, Koren G, Vandenbergh H, et al. Morphine excretion in breast milk and resultant exposure of a nursing infant. J Toxicol Clin Toxicol 1990; 28: 365–70PubMedCrossRefGoogle Scholar