Hydrocodone use while Breastfeeding
Drugs containing Hydrocodone: Vicodin, Norco, Lortab, Vicoprofen, Tussionex Pennkinetic, Hydromet, Lortab 7.5/500, Hycodan, Lorcet 10/650, Lortab 10/500, Show all 344 »Vicodin ES, Lortab 5/500, Zutripro, Reprexain, Vicodin HP, Anexsia, Rezira, Lorcet Plus, TussiCaps, Lortab ASA, Hycomine, Xodol, Narcof, Lortab 2.5/500, Vortex, Ibudone, Zydone, Tussigon, Hydrocet, Lorcet HD, Vituz, Hycoclear, M-END, Coughtuss, Hydromide, Zamicet, Codimal DH, Histinex HC, Hydrocodone CP, Hydron CP, Dolacet, Vicodin Tuss, Marcof Expectorant, Anaplex HD, Hydrotropine, Codamine, CodiCLEAR DH, Tussin-V, Triant-HC, Zolvit, Maxidone, Vicotuss, Relasin-HCX, Novasus, Tusnel-HC, Vicoclear, Cyndal HD, Poly-Tussin, Ditussin-HC, Relacon-HC, Mintuss MS, Endal HD, Hydrotuss, Hycosin Expectorant, Hydrocod-GF, Condasin, Endacof XP, Hycotuss Expectorant, Tussinate, Codamine Pediatric, Hydrocodone HD, Trimal DH, Nalex Expectorant, Histussin HC Syrup, Ventuss Syrup, Phenylephrine HD, Co-Gesic, Liquicet, Stagesic, Azdone, Alor 5/500, Histussin D, Visvex, Hycet, Duradyne DHC, Protuss, Procof, De-Chlor NX, Entuss, P-V-Tussin, S-T Forte, Exetuss-HC, Ambi 5/15/100, Execlear, MonteFlu HC, Qual-Tussin DC, Hytussin, A-Cof DH, Levall 5.0, Nariz HC, Tussicle, Hydro GP, Crantex HC, Uni-Lev 5.0, Duratuss HD, Simuc-HD, Gentex HC, Guiaplex HC, Monte-G HC, Donatussin DC, Tussafed-HC, De-Chlor G, Dynatuss HC, Tussafed-HCG, Atuss G, Hydro-Tussin HG, Pneumotussin, Pneumotussin 2.5, Tusso-DF, Pancof XP, Zymine HC, Medcodin, Gua HC, G-Tuss, Co-Tuss V Expectorant, Hycoclar Tuss, Cotuss V, Vitussin Expectorant, ColdCough HCM, Liquituss HD, Extendryl HC, Atuss HX, Tussgen, Iotussin D Liquid, Canges-XP, Xpect-HC, Touro HC, Pancof HC, SymTan, H-C Tussive D, Entuss-D Liquid, Histinex D, Z-Cof HCX, Mintuss G, Tusdec-HC, Lortuss HC, Nalex-DH, Atuss EX, Hycomal DH, Poly Hist HC, Fentuss Expectorant, Vetuss HC Syrup, KGS-HC, Hydropane, Hy-KXP, Hydron EX, Ru-Tuss with Hydrocodone, Rolatuss with Hydrocodone, Dicomal-DH, Hyco-DH, Mintuss NX, Prolex DH, Hydrocodone PA Pediatric, Hypamine, Hycophen, Hycophen Pediatric, Entuss Expectorant, PhendaCof Plus, Hydrophene DH, Codal-DH Syrup, Codituss DH, De-Chlor MR, Tussplex, Mintuss MR, Hydron KGS, Protuss-D, Detussin Expectorant, Tussend Expectorant, Tussgen Expectorant, SRC Expectorant, Poly-Tussin XP, Deconamine CX, Tussadur-HD, Vanex Expectorant, HydroFed, Nazarin HC, Hycomine Pediatric, Detussin, Decotuss-HD, Entuss-D JR, Entuss-D, Hydrotussin HD, Hydro-Tuss XP, Drituss HD, Dynex HD, Entex HC, Procof D, Pseudatex HC, Hytussin Expectorant, Tussafin Liquid, Medtuss HD, KG-Tuss HD, Spantuss HD, Vanacon, Su-Tuss HD Elixir, Tussafin, Hydex PD, Nasatuss, Chemdal HD Plus, Vanex-HD, Iotussin HC, Chlorgest HD, Hyphen-HD, Ed-Tuss HC, Guiaphen HD, Efasin-HD, Endagen-HD, Maxi-Tuss HCX, Hydrocodone GF, Chemdal HD, Iodal HD, Ed-TLC, Rindal-HD, Tuss-PD, KG-Dal HD, Highland HC, KG-Dal HD Plus, Maxi-Tuss HC, Uni Tuss HC, H-C Tussive, Cytuss HC, Histussin HC Liquid, Maxi-Tuss SA, Tuss-HC, Chemtussin HC, Endotuss-HD, Exo-Tuss, Endal-HD Plus, Comtussin HC, Enplus-HD, HyTan, S-T Forte 2, Canges-HC, Damason-P, Panasal 5/500, VasoTuss HC, BPM PE HC, FluTuss HC, Canges-HC NR, T-Gesic, Margesic H, Hy-Phen, Dolagesic, Panacet, Theracodophen Low 90, Hydrogesic, Duocet, VazoTuss HC, Brovex HC, Donatussin MAX, Excof, Max HC, Histex HC, Mintex HC, Z-Tuss 2, Tri-Vent HC, Excof-SF, Endacof HC, Drocon-CS, SymTan A, Bromplex HD, Bromph HD, J-Tan D HC, Bromcomp HC, Tuss-DS, Efasin-HD Plus, Notuss-Forte, Atuss HS, Atuss HD, Cytuss-HC NR, H-C Tussive-NR, Hycomine Compound, 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, Pneumotussin HC, Tusso-HC, Ztuss ZT, Propatuss Expectorant, Kwelcof, Co-Tussin, Vi-Q-Tuss, EndaCof-Tab, Maxi-Tuss HCG, Rindal HPD, Hydro-DP, Gestuss-HC, Dytan-HC, Execof, D-Tann HC, Hyphed, Hexatussin, De-Chlor HC, De-Chlor HD, Hydro-PC II, Atuss MS, Hydro-PC II Plus, Rindal HD Plus, Uni-Tricof HC, B-Tuss, Tussive HC, Quindal HD, Quindal HD Plus, Hi-Tuss HC, Chlorphen HD, Liquitussin HC Syrup, Duradal HD, Echotuss-HC, Phendal-HD, Pediatex HC, Histinex PV, Detuss, Tussend, Welltuss HC, Notuss, JayCof-HC, DroTuss-CP, Liquicough HC, Tusana-D, Relacon-HC NR, Poly-Tussin HD, Relasin-HC, Neo HC, Z-Cof HC, Codotuss
Hydrocodone Levels and Effects while Breastfeeding
Summary of Use during Lactation
Maternal use of maximum dosages of oral narcotics while breastfeeding can cause infant drowsiness. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics, particularly in the first week of life. However, the newborn's dosage is limited by the small volumes of colostrum in the first 2 to 3 days postpartum. Once the mother's milk comes in, it is best to limit maternal intake of oral hydrocodone (and combinations) and to supplement analgesia with a nonnarcotic analgesic if necessary. A maximum hydrocodone dosage of 30 mg daily is suggested. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants. 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
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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