A review of the available medical literature for data regarding tramadol use during breastfeeding did not reveal any cases of adverse events. These tests are not routinely done but may help healthcare professionals make individualized treatment decisions for a patient.The mother should discuss her concerns with her doctor, and her doctor may select another pain medication that is not subject to the risks associated with CYP2D6 ultra-rapid metabolism. This site does not dispense medical advice or advice of any kind.
In order for us to best serve you and provide you with the best information, can you please tell us if you currently have health insurance? Because most people do not know if they are ultra-rapid metabolizers, and because early signs of opioid overdose in an infant may be difficult to notice, breastfeeding is not recommended during treatment with codeine or tramadol.There is an FDA-cleared test to determine whether a patient is a CYP2D6 ultra-rapid metabolizer. These individuals are called CYP2D6 ultra-rapid metabolizers.In our review of the medical literature for data regarding codeine use during breastfeeding, we found numerous cases of excess sleepiness and serious breathing problems, including one death, in infants of breastfeeding mothers who were taking codeine. This page further discusses breastfeeding and morphine, including the manufacturers' recommendations. In order to circumvent morphine toxicity risks in the infant from maternal codeine use during breastfeeding, oxycodone has often been suggested as an alternative; it is mainly metabolized by CYP3A to noroxycodone, a weakly active metabolite. The amounts of codeine and morphine in breast milk are equal to or somewhat more than the mother’s amounts. I have suggested this could be a normal reaction from baby to a … However, tramadol and its metabolite M1 are also present in breast milk, and tramadol has the same risk as codeine with regard to ultra-rapid metabolism and the potential for life-threatening respiratory depression in an infant breastfeeding from a mother who is an ultra-rapid metabolizer.Healthcare professionals should be aware that breastfeeding is not recommended during treatment with codeine or tramadol due to the risk of serious adverse reactions in breastfed infants such as excess sleepiness, difficulty breastfeeding, and serious breathing problems, which may result in death. These include trouble breathing, shortness of breath, extreme drowsiness, light-headedness when changing positions, or feeling faint. Oral morphine (Oramorph®) is frequently used by mothers after a caesarean section and is compatible with breastfeeding.
Specific breastfeeding policies for chemically dependent mothers vary between hospital settings. We also encourage health care professionals to read the Drug Safety Communication regarding all new warnings the FDA is communicating about these products.The signs of opioid overdose in the breastfeeding mother are the same as can occur with any person taking an opioid.
Answers to questions about certain opioid medications and their effects on breastfed infantsCodeine is a type of pain medicine called an opioid. morphine and diamorphine are generally used post-operatively and only for short periods. Despite an excellent safety record it makes sense to attempt to reduce narcotic requirements in lactating women by using a multimodal approach to treat postoperative pain. Codeine is used to treat mild to moderate pain and also to reduce coughing where treatment with an opioid is appropriate and for which alternative treatments are inadequate. In breastfeeding mothers, the ultra-rapid conversion of codeine to morphine and tramadol to M1 can result in high and unsafe levels of morphine and M1 in blood and breast milk. As most mothers initiate breastfeeding, the safety of codeine and its pharmacologically active metabolite, morphine, among breastfed infants is of primary concern. Numerous infants have been reported to breastfeed during maternal narcotic abstinence therapy with buprenorphine with no adverse effects, one for 6 months.
NLM Web site. Even so, countless women who are breastfeeding have received morphine following surgical procedures without incident. A non-opioid analgesic should be used whenever possible.