Hydrocodone use while Breastfeeding
Drugs containing Hydrocodone: Norco, Vicodin, Lortab, Zohydro ER, Hycodan, Hydromet, Tussionex Pennkinetic, Vicoprofen, Vicodin ES, Lortab 7.5/500, Show all 345 »Lortab 5/500, Lorcet 10/650, Lortab 10/500, Zutripro, TussiCaps, Narcof, Anexsia, Vicodin HP, Hycet, Lorcet Plus, Ibudone, Reprexain, Xodol, Histussin HC Syrup, Hycomine, Maxidone, Tussigon, Hydrocet, Liquicet, Hycotuss Expectorant, Vortex, Monte-G HC, Lortab ASA, Zolvit, Vicodin Tuss, CodiCLEAR DH, Histinex HC, M-END, Rezira, Relasin-HCX, Nazarin HC, Rindal-HD, Codituss DH, Hydrocodone HD, Lortab 2.5/500, Hydromide, Entex HC, Novasus, Vituz, Hy-Phen, Codamine, Poly-Tussin, Maxi-Tuss HC, Triant-HC, Relasin-HC, Hydropane, Histussin HC Liquid, H-C Tussive, Lortuss HC, Endotuss-HD, Hydrophene DH, Hyphen-HD, Hyphed, Hydrocod-GF, Histinex PV, Vicotuss, Pancof HC, Drocon-CS, Hydrotussin HD, Dolacet, Zamicet, Zydone, Lorcet HD, Panacet, Visvex, Hycosin Expectorant, Prolex DH, Endal HD, Tri-Vent HC, Hy-KXP, Protuss, Atuss HD, Simuc-HD, Gentex HC, Entuss-D JR, Crantex HC, Mintuss G, Dynatuss HC, Uni-Lev 5.0, MonteFlu HC, Duratuss HD, Donatussin DC, Guiaplex HC, Exetuss-HC, Qual-Tussin DC, HydroFed, De-Chlor G, Nariz HC, Tussafed-HCG, Canges-XP, Pneumotussin, Pneumotussin 2.5, Medcodin, Tusso-DF, Pancof XP, Xpect-HC, Touro HC, Hycoclear, Gua HC, G-Tuss, Vicoclear, Hycoclar Tuss, Cotuss V, Hydrotuss, Vitussin Expectorant, Atuss HX, Extendryl HC, S-T Forte, Entuss, Ambi 5/15/100, Levall 5.0, Tussafed-HC, Atuss G, Execlear, Endacof XP, Condasin, Hydro-Tussin HG, Decotuss-HD, Z-Cof HCX, A-Cof DH, Tussicle, Hydro GP, Ru-Tuss with Hydrocodone, Atuss EX, Entuss Expectorant, Marcof Expectorant, Procof, Hydron EX, KGS-HC, De-Chlor NX, Mintuss NX, Hydrocodone PA Pediatric, Codamine Pediatric, PhendaCof Plus, Tussplex, Hycomine Pediatric, Hycophen, Hypamine, Hycophen Pediatric, Hydron KGS, Protuss-D, H-C Tussive D, Entuss-D Liquid, Histinex D, SymTan, Liquituss HD, Zymine HC, ColdCough HCM, Iotussin D Liquid, Hytussin, Detussin, Procof D, Histussin D, Tussafin, P-V-Tussin, Tussgen, Trimal DH, Mintuss MR, Spantuss HD, Medtuss HD, KG-Tuss HD, Vanacon, Su-Tuss HD Elixir, Hytussin Expectorant, Tussafin Liquid, Entuss-D, Poly-Tussin XP, Detussin Expectorant, Tussend Expectorant, Tussadur-HD, Tussgen Expectorant, SRC Expectorant, Deconamine CX, Nalex Expectorant, Drituss HD, Hydro-Tuss XP, Hycomal DH, Poly Hist HC, Nalex-DH, Dicomal-DH, Hyco-DH, De-Chlor MR, Codal-DH Syrup, Phenylephrine HD, Tusdec-HC, Pseudatex HC, Dynex HD, Hydrotropine, Rolatuss with Hydrocodone, Vetuss HC Syrup, Co-Tuss V Expectorant, Vanex Expectorant, Zotex HC, Guiaphen HD, Efasin-HD, Ed-TLC, Vanex-HD, Chemdal HD Plus, Iotussin HC, Nasatuss, Iodal HD, Chemdal HD, Coughtuss, Hydrocodone GF, HyTan, Mintuss MS, Maxi-Tuss HCX, Endagen-HD, Relacon-HC, Chlorgest HD, Ed-Tuss HC, Maxi-Tuss SA, Ventuss Syrup, Tuss-HC, KG-Dal HD Plus, Highland HC, Cytuss HC, Uni Tuss HC, Comtussin HC, Enplus-HD, KG-Dal HD, Tuss-PD, Cyndal HD, Ditussin-HC, Chemtussin HC, Endal-HD Plus, Exo-Tuss, S-T Forte 2, Z-Tuss 2, Panasal 5/500, Alor 5/500, Azdone, Damason-P, Tusnel-HC, VasoTuss HC, Canges-HC, T-Gesic, Margesic H, Theracodophen Low 90, Stagesic, Dolagesic, Co-Gesic, Duocet, Hydrogesic, Duradyne DHC, BPM PE HC, Canges-HC NR, Max HC, Excof-SF, Endacof HC, Excof, Donatussin MAX, Mintex HC, Histex HC, J-Tan D HC, Bromcomp HC, Brovex HC, VazoTuss HC, FluTuss HC, SymTan A, Anaplex HD, Bromph HD, Bromplex HD, Tuss-DS, Efasin-HD Plus, H-C Tussive-NR, Cytuss-HC NR, Notuss-Forte, EndaCof-Plus, Hydex PD, Hycomine Compound, Notuss PD, Atuss HS, Cordron-HC NR, P-V-Tussin Syrup, KG-Tussin, A-G Tussin, Hydrotuss HC, Hydron PCS, Cordron-HC, Hydrocof-HC, Codimal DH, Hydro-DP, Propatuss Expectorant, Pneumotussin HC, Tusso-HC, Kwelcof, Vi-Q-Tuss, Codotuss, Co-Tussin, Ztuss ZT, EndaCof-Tab, Gestuss-HC, Tussinate, Rindal HPD, Dytan-HC, D-Tann HC, Maxi-Tuss HCG, Execof, Q-V Tussin, Tussin-V, De-Chlor HD, Hydron CP, Hydro-PC II, De-Chlor HC, Atuss MS, Uni-Tricof HC, Hydro-PC II Plus, B-Tuss, Tussive HC, Hi-Tuss HC, Quindal HD, Quindal HD Plus, Chlorphen HD, Duradal HD, Hydrocodone CP, Liquitussin HC Syrup, Rindal HD Plus, Echotuss-HC, Tussend, Pediatex HC, Detuss, Welltuss HC, JayCof-HC, Hexatussin, Notuss, DroTuss-CP, Liquicough HC, Relacon-HC NR, Phendal-HD, Tusana-D, Poly-Tussin HD, Neo HC, Z-Cof HC, Fentuss Expectorant
Hydrocodone Levels and Effects while Breastfeeding
Summary of Use during Lactation
Maternal use of oral narcotics during breastfeeding can cause infant drowsiness, central nervous system depression and even death. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of oral hydrocodone to a few days at a maximum dosage of 30 mg daily with close infant monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately.
Hydrocodone is metabolized to 6 active metabolites, including hydromorphone.
Maternal Levels. Two hospitalized mothers were taking hydrocodone and acetaminophen combination for pain and pumped their milk for their nonhospitalized infants. They donated samples of their pumped milk for analysis of hydrocodone. One mother had 17 milk hydrocodone levels measured over 4 days while taking first 10 mg and then 5 mg of hydrocodone bitartrate as needed, beginning on day 7 postpartum. Her milk hydrocodone levels ranged from 8.6 to 127.3 mcg/L. The second mother had 5 milk hydrocodone levels measured over 1.5 days while taking 5 mg doses of hydrocodone bitartrate. Her milk hydrocodone levels ranged from 5.2 to 47.2 mcg/L, beginning at day 16 postpartum. Their infants received and estimated 3.1 and 3.7% of the maternal weight-adjusted dosages, but the absolute hydrocodone dosages were 8.58 mcg/kg/day and 3.07 mcg/kg/day because of the differences in the dosages ingested by their mothers.
A study of 30 postpartum women taking a hydrocodone-containing product for postpartum pain measured hydrocodone and hydromorphone in breastmilk. Milk samples were collected after lactogenesis II was judged to have occurred, usually starting on the third postpartum day. Mean and median maternal dosages of hydrocodone base were 175 and 145 mcg/kg/day, respectively (range 44.3 to 423.2 mcg/kg/day). The mean and median milk hydrocodone concentrations were 25.9 and 14.2 mcg/L, respectively. Only 12 of the 30 women had hydromorphone detectable (>1 mcg/L) in their milk with a median milk hydromorphone concentration of 1.9 mcg/L. Mean and median infant dosage of hydrocodone were 3.9 and 2.1 mcg/kg daily, respectively, which were equal to 2.4 and 1.6% of the weight-adjusted maternal dosage, respectively. Mean and median infant dosage of hydromorphone were 2.1 and 0.3 mcg/kg daily, respectively. Two women excreted much more hydromorphone into their milk than the others and might represent ultrarapid CYP2D6 metabolizers. Taking the two narcotics' potencies into account, a fully breastfed neonate would receive a mean and median of 1.5 and 0.7% of the minimum infant therapeutic opiate dosage; however, neonates might be more susceptible to the opiates than the older infants on whom these dosages were based. The authors concluded that maternal dosages of hydrocodone bitartrate up to 30 to 35 mg daily are unlikely to adversely affect breastfed neonates, but that prolonged use of dosages over 40 mg daily should be avoided during breastfeeding.
Infant Levels. Relevant published information was not found as of the revision date.
Effects in Breastfed Infants
The 18-day-old infant of a breastfeeding mother became groggy and "slept for most of the day" while the mother was taking 20 mg of oral hydrocodone combined with 1300 mg of acetaminophen every 4 hours for painful nipple candidiasis and mastitis. The mother decreased her dose by one-half and the infant apparently no longer experienced grogginess or hypersomnolence. The infant's symptoms were probably due to the maternal hydrocodone.
A 5-week-old breastfed infant became cyanotic and required mouth-to-mouth resuscitation and intubation. The infant's urine was positive for opioids and the infant responded positively to naloxone; the level of consciousness improved over 2 days and extubation was accomplished. The infant's mother admitted to taking a hydrocodone-acetaminophen combination product and methadone that had been prescribed for migraine headache before she was breastfeeding. The infant's symptoms were probably due to the maternal opiate use.
Possible Effects on Lactation
Narcotics can increase serum prolactin. However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.
Alternate Drugs to Consider
1. Anderson PO, Sauberan J, Lane JR, Rossi SS. Hydrocodone excretion into breastmilk: the first two reported cases. Breastfeed Med 2007;2:10-4. PMID: 17661614
2. Sauberan JB, Anderson PO, Lane JR et al. Breast milk hydrocodone and hydromorphone levels in mothers using hydrocodone for postpartum pain. Obstet Gynecol. 2011;117:611-7. PMID: 21343764
3. Bodley V, Powers D. Long-term treatment of a breastfeeding mother with fluconazole-resolved nipple pain caused by yeast: a case study. J Hum Lact. 1997;13:307-11. PMID: 9429366
4. Meyer D, Tobias JD. Adverse effects following the inadvertent administration of opioids to infants and children. Clin Pediatr (Phila). 2005;44:499-503. PMID: 16015396
5. Tolis G, Dent R, Guyda H. Opiates, prolactin, and the dopamine receptor. J Clin Endocrinol Metab. 1978;47:200-3. PMID: 263291
CAS Registry Number
- Analgesics, Opioid
- Antitussive Agents
LactMed Record Number
Information from the National Library of Medicine's LactMed Database.
Last Revision Date
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