Is it safe to prescribe oxycodone (opioid analgesic) to a pregnant woman?

From the Guidelines

Oxycodone should only be prescribed to a pregnant woman when the potential benefits outweigh the risks and alternative non-opioid pain management strategies have been considered first. According to the American Journal of Obstetrics and Gynecology 1, for opioid-naïve women, nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen should be given as first-line treatments for pain after a routine vaginal birth or cesarean delivery. A short course of low-dose opioids, such as oxycodone, can be considered for severe pain that is not managed effectively by nonopioid options.

Key Considerations

• Prolonged use of oxycodone during pregnancy can lead to neonatal opioid withdrawal syndrome (NOWS) in the newborn, characterized by irritability, poor feeding, respiratory problems, and seizures 1.
• Oxycodone crosses the placenta and may cause respiratory depression in the newborn if used near delivery.
• Alternative non-opioid pain management strategies, including acetaminophen, physical therapy, and non-pharmacological approaches, should be considered first.
• If oxycodone is deemed necessary, close monitoring by healthcare providers is essential, and a gradual tapering plan should be implemented before delivery to minimize withdrawal symptoms in the newborn.

Recommendations

• Oxycodone should be prescribed at the lowest effective dose for the shortest duration possible.
• A shared decision-making process should be used to select the number of opioid tablets to be prescribed, with no more than the equivalent of 20 5-mg tablets of oxycodone 1.
• Women should be counseled about the benefits and risks of opioids, side effects, and potential for misuse.
• Antenatal counseling and care should include education about neonatal opioid withdrawal syndrome, breastfeeding, and postpartum pain control options 1.

From the FDA Drug Label

Prolonged use of oxycodone hydrochloride tablets during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated. If prolonged opioid use is required in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available.

The use of oxycodone in pregnant women should be approached with caution. Prolonged use of oxycodone during pregnancy can lead to neonatal opioid withdrawal syndrome, which can be life-threatening. If oxycodone is required for a pregnant woman, it is essential to:

• Advise the patient of the risk of neonatal opioid withdrawal syndrome
• Ensure that appropriate treatment will be available for the newborn It is crucial to weigh the benefits and risks of oxycodone use in pregnant women and consider alternative treatment options when possible 2.

From the Research

Safety of Oxycodone in Pregnancy

• The safety of prescribing oxycodone to a pregnant woman is a concern due to the potential risks to the fetus and the mother 3.
• Oxycodone exposure during pregnancy has been associated with a reduction in average length of gestation, preterm birth, and an increased risk of admission to the special care nursery 3.
• However, oxycodone exposure was not associated with an increased risk of congenital anomalies 3.

Alternative Treatments

• Medication-assisted treatment with methadone or buprenorphine is the standard of care for opioid use disorder during pregnancy 4, 5, 6, 7.
• Buprenorphine may be associated with more favorable neonatal and maternal outcomes than methadone 7.
• Methadone and buprenorphine have risks and benefits that should be explored before initiating treatment 4.

Considerations for Treatment

• Pregnant women dependent on opioids require careful treatment to minimize harm to the fetus and neonate and improve maternal health 6.
• Treatment decisions must encompass the full clinical picture, with respect to frequent complications arising from psychiatric comorbidities and the concomitant consumption of other drugs 6.
• Frequent monitoring, particularly in the third trimester, is necessary for women undergoing treatment 4.