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