Can I breastfeed after being given Dilaudid (hydromorphone) and fentanyl?

From the Guidelines

It is recommended to continue breastfeeding as normal after receiving Dilaudid (hydromorphone) and fentanyl, without the need to express and discard breast milk, as the risks to the infant are considered low 1. When considering the use of opioids like Dilaudid and fentanyl in breastfeeding women, it's essential to weigh the benefits of breastfeeding against the potential risks of infant exposure to these medications.

• The transfer of these drugs into breast milk is relatively small, and their effects on the breastfed infant are typically minimal 1.
• However, it's crucial to observe the infant for signs of abnormal drowsiness and respiratory depression, especially in babies up to 6 weeks old (corrected for gestational age) 1.
• If sedation and drowsiness develop in the infant, breastfeeding should be withheld, and medical advice should be sought.
• Multimodal analgesia with non-opioid drugs, such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), is recommended to minimize opioid use 1.
• Breastfeeding support should be accessible for lactating women undergoing surgical and medical procedures, and patient information leaflets should be available to provide guidance on breastfeeding support in the peri-operative period 1.
• The benefits of breastfeeding, including its health benefits for the mother and infant, should be considered when making decisions about breastfeeding and medication use 1.

From the FDA Drug Label

Fentanyl is excreted in human milk; therefore, fentanyl transdermal system is not recommended for use in nursing women because of the possibility of effects in their infants Because of the potential for serious adverse reactions, including excess sedation and respiratory depression in a breastfed infant, advise patients that breastfeeding is not recommended during treatment with fentanyl transdermal system.

Breastfeeding is not recommended after being given Dilaudid (hydromorphone) and fentanyl, due to the potential for serious adverse reactions in the breastfed infant, including excess sedation and respiratory depression.

• The effects of hydromorphone on breastfeeding are not directly addressed in the provided drug labels.
• However, based on the information available for fentanyl, it is recommended to avoid breastfeeding to minimize the risk of adverse reactions in the infant 2.

From the Research

Breastfeeding after Receiving Dilaudid and Fentanyl

• The administration of Dilaudid (hydromorphone) and fentanyl to a breastfeeding mother can be a concern due to the potential transfer of these drugs to the infant through breast milk 3, 4.
• Studies suggest that the amount of drug transferred to the infant can be minimized by administering the lowest possible dose to the mother and avoiding breastfeeding during times of peak drug concentration in milk 3, 4.
• For fentanyl, specifically, research indicates that the amount of drug excreted into breast milk is relatively small, with one study finding that an average of 0.033% of the maternal fentanyl dose was collected in milk over 24 hours 5.
• Another study found that labor epidural solutions containing fentanyl concentrations as high as 2 μg/ml did not appear to influence breastfeeding rates at 6 weeks postpartum 6.
• Additionally, a study comparing the effects of epidural and intravenous fentanyl on breastfeeding behaviors and fentanyl concentration in colostrum found no statistical difference in breastfeeding behaviors at birth or at 24 hours of age in both groups 7.

Considerations for Breastfeeding

• Mothers who receive Dilaudid and fentanyl should be informed about the potential risks and benefits of breastfeeding and should discuss any concerns with their healthcare provider 3, 4.
• The decision to continue breastfeeding after receiving these drugs should be made on an individual basis, taking into account the potential risks to the infant and the benefits of breastfeeding 3, 4.
• If a mother chooses to continue breastfeeding, she should be monitored for any signs of adverse effects in the infant, and the infant should be observed for any potential adverse effects 4.