Is Endone (codeine) safe during pregnancy?

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Last updated: May 12, 2025View editorial policy

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From the Guidelines

Endone (oxycodone) should be used with extreme caution during pregnancy and only when the potential benefits outweigh the risks, due to the potential for neonatal opioid withdrawal syndrome and other adverse effects on the fetus 1. When considering pain management during pregnancy, it's crucial to weigh the risks and benefits of any medication. Oxycodone, an opioid, can cross the placenta and may affect fetal development, particularly with regular use in the third trimester. Prolonged use during pregnancy can lead to neonatal opioid withdrawal syndrome in newborns, which may require specialized care after birth. According to the provided evidence, opioids such as oxycodone can cause neonatal abstinence syndrome (NAS), with withdrawal signs developing in 55% to 94% of neonates exposed to opioids in utero 1. Given these risks, alternative pain management strategies such as acetaminophen (paracetamol) are typically preferred during pregnancy when possible. Any pregnant woman requiring pain management should discuss all options with her healthcare provider, who can make individualized recommendations based on her specific situation, pain severity, and stage of pregnancy. Key considerations include:

  • Using the lowest effective dose for the shortest duration possible
  • Close medical supervision
  • Monitoring for signs of neonatal opioid withdrawal syndrome in newborns
  • Exploring alternative pain management options whenever possible.

From the Research

Safety of Endone in Pregnancy

There is no direct evidence in the provided studies regarding the safety of Endone in pregnancy.

  • The studies focus on neonatal opioid withdrawal syndrome (NOWS) and the treatment of infants born to mothers who used opioids during pregnancy 2, 3, 4, 5, 6.
  • None of the studies mention Endone specifically, but they do discuss the use of opioids such as morphine, methadone, and buprenorphine in the treatment of NOWS 3, 4, 6.
  • The studies suggest that non-pharmacological care and pharmacological treatment with opioids or sedatives may be used to manage NOWS, but the safety and efficacy of these treatments are not well established 2, 3, 5.
  • Further research is needed to determine the safety and efficacy of treatments for NOWS, including the use of opioids such as Endone 2, 3, 5, 6.

Key Findings

  • There is limited evidence on the safety and efficacy of treatments for NOWS, including the use of opioids and sedatives 2, 3, 4, 5, 6.
  • Non-pharmacological care and pharmacological treatment with opioids or sedatives may be used to manage NOWS, but the safety and efficacy of these treatments are not well established 2, 3, 5.
  • Further research is needed to determine the safety and efficacy of treatments for NOWS, including the use of opioids such as Endone 2, 3, 5, 6.

Gaps in Knowledge

  • There is a lack of evidence on the safety and efficacy of Endone in pregnancy 2, 3, 4, 5, 6.
  • Further research is needed to determine the safety and efficacy of treatments for NOWS, including the use of opioids such as Endone 2, 3, 5, 6.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Non-pharmacological care for opioid withdrawal in newborns.

The Cochrane database of systematic reviews, 2020

Research

Sedatives for opioid withdrawal in newborn infants.

The Cochrane database of systematic reviews, 2021

Research

Neonatal opioid withdrawal syndrome: a review of the science and a look toward the use of buprenorphine for affected infants.

Journal of perinatology : official journal of the California Perinatal Association, 2022

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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