Breastmilk and Codeine

One of the more delicate balances in mother-baby nursing is the need for the mother’s pain to be controlled with medications while preventing harm to the newborn from those medications being passed through breastmilk. Healthcare practitioners including lactation consultants are well versed on what medications are considered safe for use during lactation and which ones are not. Mothers are often provided education regarding both prescription and non-prescription medications and their effect on the baby through breastmilk consumption prior to delivery.

One of the most widely used pain medications for post-partum mothers is codeine. Codeine is found in both prescription and non-prescription medications. It is used most often in cough and pain medications. When codeine is ingested, it is converted (or metabolized) in the body to morphine.

Some people metabolize codeine very rapidly. These individuals are referred clinically to as Ultra-Rapid Metabolizers. These individuals process codeine to morphine so quickly that they have been found to have higher than normal levels of morphine in their system. For breastfeeding mothers who are ultra-rapid metabolizers, this means that the amount of codeine that is converted to morphine and then excreted in their breastmilk is done so at a much higher level.

The chances of someone being an ultra-rapid metabolizer is 1 in 100 people. Codeine has been used safely in breastfeeding women for years and has long been considered the safest choice of narcotic pain relievers to given lactating mothers. Recently, the FDA became aware of a journal article that sought to describe a 13 day old infant who succumbed to the side effects of morphine overdose. It was discovered that the mother was treated with small doses of codeine after delivery but her breastmilk was excreting high amounts of morphine to her baby.

The FDA is not suggesting that codeine be barred from use for lactating mothers. They have instead recommended that healthcare practitioners prescribe the smallest amount of effective doses for the shortest amount of time needed to produce desired pain relief. They also have encouraged health practitioners to provide patient education regarding the early signs of morphine overdose seen in newborns. These signs include; increased sleepiness, difficulty breastfeeding, breathing difficulties or limpness. Should parents recognize these signs in their child, the pediatrician should be contacted immediately.

For more information on this topic or if you have a medical record you would like to have reviewed please contact our office.

Reference:

Food and Drug Administration. FDA Warning on Codeine Use by Nursing Mothers. Retrieved August 2007 from: http://www.fda.gov/bbs/topics/NEWS/2007/NEW01685.html

For more information on this issue please see Contact Us and see how our services can work for you.