Breastfeeding and Analgesia
A useful resource for clinicians was the US National Library of Medicine’s LactMed database which gave an up to date review of evidence regarding the safety of opioids in breastfeeding, but is no longer being maintained.
There is a USA based advisory database LactMed database which gives more general advice on the safety of any drug in breastfeeding. [The advice for codeine is from 2018 and does not reflect the newer infromation discussed below]. This Breastfeeding Network has more information on some analgesics and this paper gives more information on the pharmacokinetics of breastmilk transfer.
For women on Methadone or Buprenorphine as opioid substitution therapy for drug addiction, breastfeeding should be encouraged providing there are no contraindications such as other drugs of abuse taken, or HIV infection. Minimal levels of methadone or buprenorphine are found in breast milk regardless of the maternal dose, and any transfer of drug will mitigate symptoms of neonatal abstinence syndrome (NAS).
Contact the pain team for more support and advice Useful Contact Details within OUH.
Concerns over the use of Codeine in breastfeeding women originated from a case report published in 2006 [Madadi]. This was subsequently retracted in 2021 [Tsuyuki] following a paper which comprehensively proved the implausability of the original conclusions [Zipursky and Juurlink]. Despite this, the Medicines and Healthcare products Regulatory Authority (MHRA), European Medicines Authority (EMA) and Royal College of Obstetricians and Gynaecologists continue to advise against use of codeine in breastfeeding women.
In the OUH, dihydrocodeine is currently the preferred weak opioid for breastfeeding mothers. It should be used at the lowest dose for the shortest time.
Recommended use of analgesics in breastfeeding mothers
