Is it safe to breastfeed while taking hydrocodone (opioid analgesic)?

Hydrocodone and Breastfeeding: Safety Considerations

Hydrocodone should be used with caution during breastfeeding, with close monitoring of the infant for signs of sedation, respiratory depression, and feeding difficulties. 1

Transfer into Breast Milk and Infant Exposure

• Hydrocodone passes into breast milk, with infants receiving approximately 3.1-3.7% of the maternal weight-adjusted dosage 2
• The absolute infant dosage varies significantly based on maternal dose, ranging from 3.07-8.58 μg/kg per day in documented cases 2
• The FDA drug label explicitly states that "hydrocodone bitartrate and acetaminophen tablets passes into breast milk and may harm your baby" 3

Risk Assessment and Monitoring

• As with all opioids, there is risk of infant sedation, respiratory depression, and decreased alertness 1
• Infants should be closely monitored for:
  • Increased sleepiness 1
  • Difficulty breathing 1
  • Decreased alertness 1
  • Feeding problems 1
• Neonates and preterm infants may be more susceptible to adverse effects than older infants 2

Recommendations for Use

• If pain management is necessary during breastfeeding, consider these alternatives first:

  • Acetaminophen and ibuprofen are preferred analgesics during lactation 4
  • Dihydrocodeine may be a preferred weak opioid due to its cleaner metabolism compared to other opioids 1
  • Ketorolac (Toradol) is considered safe for breastfeeding women and recommended over opioids 5

• If hydrocodone must be used:

  • Use the lowest effective dose for the shortest time possible 3, 6
  • Time administration to occur just after breastfeeding or before infant's longest sleep period 4
  • For single or short-term use, the risk to the infant is likely minimal 2, 6
  • Long-term use requires more careful consideration of risks versus benefits 6

Special Considerations

• The Association of Anaesthetists recommends caution with all opioids in breastfeeding women 1
• The amount of medication that enters breast milk varies based on maternal serum concentration and pharmacologic properties 4
• If signs of opioid toxicity appear in the infant, seek immediate medical attention 3

Common Pitfalls to Avoid

• Failing to monitor the infant for signs of opioid effects 1
• Using higher doses than necessary for pain control 3, 6
• Continuing opioid use longer than necessary when non-opioid alternatives would suffice 4
• Not considering the infant's age and health status when assessing risk (younger infants are at higher risk) 2