Hydrocodone use while Breastfeeding

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

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.

Effects on Lactation and Breastmilk

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

Last Revision Date

20140116

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