From the Guidelines
It's generally recommended to wait at least 2-4 hours after receiving fentanyl before breastfeeding your baby, as fentanyl clears from your system relatively quickly. However, for Dilaudid (hydromorphone), the waiting time is less clear, but considering the general principles of opioid excretion into breast milk, a waiting period of 4-6 hours may be prudent 1. The timing may vary depending on the dose you received and your individual metabolism. If possible, consider pumping and discarding breast milk during this waiting period to maintain your supply. Watch your baby for signs of drowsiness, difficulty breathing, or poor feeding after breastfeeding resumes. These medications are often given for acute pain management, such as after surgery or during labor, and the benefits of pain control must be balanced with minimizing infant exposure. Some key points to consider include:
- Breastfeeding support should be accessible for lactating women undergoing surgical and medical procedures 1.
- Opioid-sparing techniques are preferable for the breastfeeding woman, and local and regional anaesthesia have benefits in this regard 1.
- If you need ongoing pain medication, discuss with your healthcare provider about switching to options that may be safer for breastfeeding, such as ibuprofen or acetaminophen once acute pain subsides 1. It is also important to note that expressing and discarding (‘pumping and dumping’) of breast milk after anaesthesia is not necessary, but some women may wish to ensure that their infant is not exposed to any medication at all 1. Prior expression and storage of milk may be possible, and evidence-based material should be provided on the elimination time of the drugs so that she can resume normal breastfeeding as soon as possible 1. Ultimately, the decision to breastfeed after receiving these medications should be made in consultation with your healthcare provider, taking into account your individual circumstances and the potential risks and benefits 1.
From the Research
Waiting to Breastfeed after Receiving Dilaudid (Hydromorphone) and Fentanyl
- The amount of time to wait before breastfeeding after receiving Dilaudid (hydromorphone) and fentanyl is not explicitly stated in the provided studies, but some guidelines can be inferred from the available data.
- A study on the pharmacokinetics of midazolam, propofol, and fentanyl transfer to human breast milk found that the amount of fentanyl excreted into milk within 24 hours of induction of anesthesia was relatively small, representing an average of 0.033% of the maternal dose 2.
- Another study on opioids in breast milk suggested that opioid use for pain management during labor and delivery and subsequent short-term use for 2-3 days are compatible with breastfeeding, but newly initiated and prolonged maternal opioid therapy must be closely monitored 3.
- A case report of a 6-day-old breast-feeding infant whose mother was taking hydromorphone for pain relief from a cesarean delivery highlighted the importance of thorough medication history taking in postpartum breast-feeding mothers whose infants may present with symptoms of opiate toxicity 4.
- A study on the influence of intrapartum opioid use on breastfeeding experience found that women who received fentanyl experienced fewer difficulties in establishing breastfeeding by 6 weeks postpartum compared to those who received pethidine 5.
- A pharmacokinetic study of hydrocodone and hydromorphone levels in breast milk found that fully breastfed neonates received 1.6% of the maternal weight-adjusted hydrocodone bitartrate dosage, and standard postpartum dosages of hydrocodone bitartrate appear to be acceptable to use in women nursing newborns 6.
General Guidelines
- Based on the available data, it is recommended to wait at least 24 hours after receiving fentanyl before breastfeeding, as the amount of fentanyl excreted into milk within this time frame is relatively small 2.
- For hydromorphone, the waiting time is not explicitly stated, but it is recommended to exercise caution and monitor the infant closely for signs of opiate toxicity 4.
- It is essential to consult with a healthcare provider to determine the best course of action for individual cases, as the safety of breastfeeding after receiving opioids depends on various factors, including the type and dose of the opioid, the duration of use, and the individual characteristics of the mother and infant 3.