Can a newborn boy, whose mother is on methadone (dolophine) for opioid addiction and sertraline (zoloft) for depression, be breastfed given the maternal and newborn urine drug screens are positive for opioids?

From the Guidelines

The mother can breastfeed her newborn while on methadone and sertraline, as the benefits of breastfeeding generally outweigh the potential risks. Methadone is compatible with breastfeeding, as only small amounts transfer into breast milk 1. The American Academy of Pediatrics supports breastfeeding for mothers on stable methadone maintenance therapy. Sertraline is also considered one of the preferred antidepressants during lactation due to minimal transfer into breast milk, with studies showing that it provides the infant with less than 10% of the maternal daily dose normalized for weight 1.

Breastfeeding in this situation offers several benefits, including:

• Reducing the severity of neonatal abstinence syndrome (NAS) in infants exposed to opioids in utero
• Providing skin-to-skin contact that helps with bonding
• Delivering nutritional benefits The mother should be encouraged to continue her substance abuse treatment program while breastfeeding. She should be advised to avoid alcohol consumption while breastfeeding and understand that if she relapses to using illicit substances, she should temporarily suspend breastfeeding. Regular follow-up for both mother and infant is important to monitor the baby's development and the mother's recovery progress 1.

From the FDA Drug Label

Methadone is secreted into human milk. The safety of breastfeeding while taking oral methadone is controversial At maternal oral doses of 10 to 80 mg/day, methadone concentrations from 50 to 570 µg/L in milk have been reported, which, in the majority of samples, were lower than maternal serum drug concentrations at steady state. Methadone-treated mothers considering nursing an opioid-naïve infant should be counseled regarding the presence of methadone in breast milk Because of the potential for serious adverse reactions in nursing infants from methadone, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother, and weighing the risk of methadone against the risk of maternal illicit drug use

The mother should be counseled about the presence of methadone in breast milk and the potential for serious adverse reactions in the newborn. A decision should be made to either discontinue breastfeeding or discontinue the methadone, considering the importance of the drug to the mother and weighing the risks. 2

From the Research

Breastfeeding Considerations

• The mother is taking methadone as part of an addiction management program and sertraline for depression, and is inquiring about breastfeeding her newborn 3, 4.
• Studies have shown that methadone is present in breast milk, but at low concentrations, and that breastfeeding seems to be safe for infants of mothers on methadone maintenance 5.
• Sertraline is also considered safe for use during breastfeeding, with low levels of exposure in breastfed infants and few reported adverse events 6.

Methadone and Breastfeeding

• Methadone concentrations in breast milk are low and not related to maternal dose, with a range of 21.0-462.0 ng/mL 5.
• Infants of mothers on methadone maintenance who breastfeed may have lower rates of neonatal abstinence syndrome, although this finding is not statistically significant 5.
• Breastfeeding is recommended for methadone-maintained women, as it offers physical and psychological benefits for both mothers and infants 3, 5, 7.

Sertraline and Breastfeeding

• Sertraline is a first-line drug for breastfeeding women due to its low levels of exposure in breastfed infants and few reported adverse events 6.
• The correlation between maternal and infant sertraline concentrations is not significant, and routine serum sampling or genotyping is not warranted for breastfeeding mothers taking sertraline 6.
• Women taking sertraline should be advised to breastfeed and continue their medication, with careful monitoring of the newborn for adverse effects 4.