Oxycodone and Breastfeeding: Safety Considerations
Breastfeeding mothers should limit oxycodone use to the lowest effective dose (maximum 30 mg daily) and monitor infants closely for signs of central nervous system depression, as oxycodone passes into breast milk and can cause adverse effects in breastfed infants. 1, 2
Risk Assessment
- Oxycodone is present in breast milk, with studies showing it becomes concentrated in human breast milk with a milk-to-plasma ratio of approximately 3.2:1 3
- Maternal oxycodone use during breastfeeding is associated with a 20.1% rate of infant central nervous system (CNS) depression, significantly higher than acetaminophen (0.5%) 4
- Higher maternal doses of oxycodone correlate with increased risk of infant CNS depression (median 0.4 mg/kg/day in mothers of symptomatic infants vs. 0.15 mg/kg/day in mothers of asymptomatic infants) 4
- The FDA drug label acknowledges that oxycodone is present in breast milk but notes that lactation studies specifically with oxycodone tablets have not been conducted 1
Signs of Infant CNS Depression to Monitor
- Increased sleepiness or sedation 1, 5
- Difficulty breathing or respiratory depression 1, 5
- Feeding problems or difficulty latching 5
- Cyanosis (bluish discoloration of skin) 5
- Decreased alertness 1
Recommendations for Safe Use
- A maximum daily dose of 30 mg of oxycodone is recommended for breastfeeding women 2
- Mothers should take oxycodone after breastfeeding to minimize infant exposure 6
- Use the lowest effective dose for the shortest duration possible 6
- Consider non-opioid analgesics (acetaminophen, NSAIDs) as first-line options when appropriate 2
- If oxycodone is necessary, monitor the infant closely for signs of CNS depression 1, 5
Important Considerations
- Oxycodone is not a safer alternative to codeine for breastfeeding mothers, contrary to what some may believe 4
- Mothers are significantly more likely to experience sedative adverse effects from oxycodone compared to codeine 4
- Inadequate pain control can also negatively impact breastfeeding, so appropriate pain management remains important 2
- Some infants may receive more than 10% of a therapeutic infant dose through breast milk, though risk is minimized in the first 72 hours postpartum when milk volume is lower 3
Common Pitfalls to Avoid
- Failing to monitor infants for signs of opioid toxicity when mothers are taking oxycodone 1, 5
- Using unnecessarily high doses of oxycodone when lower doses may provide adequate analgesia 2, 4
- Not considering multimodal analgesia (scheduled acetaminophen and NSAIDs) to reduce opioid requirements 2
- Overlooking the possibility of withdrawal symptoms in infants when maternal oxycodone administration is stopped 1