Hydrocodone use while Breastfeeding

Drugs containing Hydrocodone: Norco, Vicodin, Lortab, Zohydro ER, Vicoprofen, Tussionex Pennkinetic, Hydromet, Hycodan, Vicodin ES, Hycet, Show all 342 »Lorcet 10/650, Lorcet, Anexsia, Vicodin HP, Narcof, Zutripro, TussiCaps, Xodol, Tussigon, Hydrocet, Vortex, Hycotuss Expectorant, Lorcet Plus, Reprexain, Maxidone, Zamicet, Vituz, Hydrotropine, Zolvit, Hydrocodone CP, Hycomine, Vicotuss, Quindal HD, Zydone, Histussin HC Syrup, Triant-HC, Liquicet, Hytussin, Damason-P, Lortab ASA, Monte-G HC, Vitussin Expectorant, Vicodin Tuss, M-END, Co-Gesic, Novasus, Lorcet HD, Stagesic, Vanex-HD, Ibudone, Nalex Expectorant, Hycophen, Chemdal HD Plus, Welltuss HC, Atuss G, Hydrocodone HD, Relasin-HC, Codal-DH Syrup, De-Chlor MR, Liquitussin HC Syrup, Histussin HC Liquid, Trimal DH, Levall 5.0, Histinex HC, Enplus-HD, Relacon-HC, Canges-XP, G-Tuss, Hycosin Expectorant, Vicoclear, Hydrotuss, Cotuss V, Pancof HC, Histussin D, Hycoclar Tuss, Bromplex HD, Kwelcof, Dolacet, Tri-Vent HC, Theracodophen Low 90, Relasin-HCX, Uni-Lev 5.0, Gua HC, Duratuss HD, Crantex HC, Codotuss, Fentuss Expectorant, Simuc-HD, Co-Tuss V Expectorant, Qual-Tussin DC, HydroFed, Nazarin HC, Mintuss G, Entuss-D JR, Vanex Expectorant, Decotuss-HD, MonteFlu HC, Co-Tussin, Guiaplex HC, Donatussin DC, Exetuss-HC, Tussafed-HCG, Nariz HC, Gentex HC, Tussafed-HC, Pneumotussin, Tusso-DF, Pneumotussin 2.5, Condasin, Z-Cof HCX, Pancof XP, Touro HC, Hydro-Tussin HG, Extendryl HC, Atuss HX, Xpect-HC, Tussicle, A-Cof DH, De-Chlor G, Hydro GP, Dynatuss HC, Medcodin, Hydrocod-GF, Tussadur-HD, Ambi 5/15/100, Endacof XP, Execlear, Entuss, S-T Forte, Hycoclear, Rolatuss with Hydrocodone, Entuss Expectorant, Marcof Expectorant, Protuss, Atuss EX, Procof, De-Chlor NX, Hydron EX, Prolex DH, Mintuss NX, Codamine Pediatric, Codamine, PhendaCof Plus, Hycomine Pediatric, Hycophen Pediatric, Hydrocodone PA Pediatric, Hypamine, Hy-KXP, KGS-HC, SymTan, H-C Tussive D, Entuss-D Liquid, Liquituss HD, ColdCough HCM, Zymine HC, Rezira, Histinex D, Iotussin D Liquid, Procof D, Protuss-D, Hydron KGS, Detussin, Tussafin, P-V-Tussin, Tussgen, Tussplex, Mintuss MR, Su-Tuss HD Elixir, Vanacon, Spantuss HD, Tussafin Liquid, Hytussin Expectorant, Hydro-Tuss XP, Drituss HD, Medtuss HD, KG-Tuss HD, SRC Expectorant, Tussgen Expectorant, Detussin Expectorant, Deconamine CX, Poly-Tussin XP, Hydrotussin HD, Entuss-D, Dynex HD, Entex HC, Hycomal DH, Poly Hist HC, Nalex-DH, Dicomal-DH, Hyco-DH, Codituss DH, Hydrophene DH, Phenylephrine HD, Tusdec-HC, Hydropane, Hydromide, Pseudatex HC, Vi-Q-Tuss, Ru-Tuss with Hydrocodone, Lortuss HC, Vetuss HC Syrup, Tussend Expectorant, Codimal DH, Efasin-HD, Ed-TLC, Rindal-HD, Guiaphen HD, Nasatuss, Chlorgest HD, Iotussin HC, Iodal HD, Chemdal HD, Hydrocodone GF, HyTan, S-T Forte 2, Coughtuss, Mintuss MS, Endagen-HD, Maxi-Tuss HCX, Ed-Tuss HC, Cyndal HD, Ventuss Syrup, Tuss-HC, Comtussin HC, Maxi-Tuss SA, Maxi-Tuss HC, Highland HC, KG-Dal HD Plus, Endal-HD Plus, Exo-Tuss, Tuss-PD, Hyphen-HD, KG-Dal HD, Endotuss-HD, Chemtussin HC, Ditussin-HC, Z-Tuss 2, Mintex HC, Panasal 5/500, Alor 5/500, Azdone, Tusnel-HC, Canges-HC, BPM PE HC, VasoTuss HC, Anolor DH5, T-Gesic, Panacet, Hy-Phen, Dolagesic, Duocet, Duradyne DHC, Margesic H, Hydrogesic, Canges-HC NR, FluTuss HC, Excof-SF, Endacof HC, J-Tan D HC, Max HC, Excof, Histex HC, Donatussin MAX, Bromcomp HC, Visvex, Brovex HC, VazoTuss HC, SymTan A, Drocon-CS, Bromph HD, Anaplex HD, Uni Tuss HC, H-C Tussive, Notuss-Forte, Atuss HS, Atuss HD, Cytuss-HC NR, H-C Tussive-NR, Hydex PD, EndaCof-Plus, Cordron-HC NR, Cordron-HC, KG-Tussin, A-G Tussin, Q-V Tussin, P-V-Tussin Syrup, Hydrotuss HC, Hydrocof-HC, Hydron PCS, Notuss PD, Zotex HC, Maxi-Tuss HCG, CodiCLEAR DH, Execof, EndaCof-Tab, Ztuss ZT, Pneumotussin HC, Tusso-HC, D-Tann HC, Dytan-HC, Hydro-DP, Hycomine Compound, Rindal HPD, Endal HD, Gestuss-HC, Tussinate, Tussin-V, Hyphed, De-Chlor HD, Hydron CP, Hydro-PC II, De-Chlor HC, Atuss MS, Uni-Tricof HC, Hydro-PC II Plus, B-Tuss, Tussive HC, Efasin-HD Plus, Tuss-DS, Cytuss HC, Quindal HD Plus, Hi-Tuss HC, Duradal HD, Chlorphen HD, Rindal HD Plus, Echotuss-HC, Pediatex HC, Histinex PV, Detuss, Tussend, JayCof-HC, Hexatussin, Notuss, DroTuss-CP, Liquicough HC, Relacon-HC NR, Phendal-HD, Tusana-D, Poly-Tussin HD, Neo HC, Z-Cof HC, Propatuss 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.

Drug Levels

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.[1]

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.[2]

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.[3] 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.[4] The infant's symptoms were probably due to the maternal opiate use.

Possible Effects on Lactation

Narcotics can increase serum prolactin.[5] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.

Alternate Drugs to Consider

Acetaminophen, Butorphanol, Hydromorphone, Ibuprofen, Morphine

References

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

Hydrocodone Identification

Substance Name

Hydrocodone

CAS Registry Number

125-29-1

Drug Class

  • Analgesics, Opioid
  • Narcotics
  • Antitussive Agents

Administrative Information

LactMed Record Number

359

Information from the National Library of Medicine's LactMed Database.

Last Revision Date

2014-01-16

Disclaimer

Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

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