Hydrocodone use while Breastfeeding

Drugs containing Hydrocodone: Norco, Vicodin, Lortab, Zohydro ER, Vicoprofen, Tussionex Pennkinetic, Hycodan, Hydromet, Lorcet, Vicodin ES, Show all 344 »Hycet, Lorcet 10/650, Zutripro, Vicodin HP, Narcof, Anexsia, Reprexain, TussiCaps, Xodol, Protuss, Lorcet Plus, Monte-G HC, Tussigon, Lortab ASA, Hycomine, Hycotuss Expectorant, Stagesic, Hydrocodone HD, Ibudone, Lorcet HD, Hydrocodone CP, Mintuss NX, Zydone, Zolvit, Triant-HC, Coughtuss, Vanex-HD, Novasus, Hydrocod-GF, Rezira, Lortuss HC, Hydropane, Hydromide, Codimal DH, Levall 5.0, Histussin HC Syrup, Endal HD, Endacof HC, Damason-P, De-Chlor HC, Relacon-HC, CodiCLEAR DH, Hydro-PC II, Tusnel-HC, Condasin, Atuss HX, Vortex, Marcof Expectorant, Prolex DH, Nazarin HC, Liquicet, Hydrophene DH, Tussinate, Anolor DH5, Hydrocet, Theracodophen Low 90, Azdone, Relasin-HCX, Vicodin Tuss, Histex HC, Su-Tuss HD Elixir, Drituss HD, JayCof-HC, Detuss, Pancof HC, Tussadur-HD, Decotuss-HD, Panacet, HyTan, Tussafin, Simuc-HD, SRC Expectorant, Duratuss HD, Crantex HC, Tussgen Expectorant, Dynatuss HC, Deconamine CX, Detussin Expectorant, Tussafed-HCG, Uni-Lev 5.0, Nalex Expectorant, Tussend Expectorant, Vanex Expectorant, Entuss-D JR, Nariz HC, HydroFed, MonteFlu HC, Qual-Tussin DC, Donatussin DC, Guiaplex HC, Exetuss-HC, Gentex HC, Tussicle, Entuss, Pneumotussin 2.5, Pneumotussin, Tusso-DF, Pancof XP, Execof, Medcodin, Hycoclear, Hycoclar Tuss, G-Tuss, Cotuss V, Vitussin Expectorant, Gua HC, Hydrotuss, Touro HC, Xpect-HC, Mintuss G, Zamicet, Atuss G, Ambi 5/15/100, Hydro GP, Tussafed-HC, S-T Forte, A-Cof DH, Hydro-Tussin HG, Extendryl HC, Canges-XP, Z-Cof HCX, Poly-Tussin XP, De-Chlor G, Hydro-Tuss XP, Entuss Expectorant, Hydrocodone PA Pediatric, Hypamine, Atuss EX, Procof, De-Chlor NX, Hydron EX, Hycophen Pediatric, Hycophen, Tussplex, Trimal DH, Mintuss MR, Poly Hist HC, Codamine, Hycomine Pediatric, Codamine Pediatric, Hy-KXP, KGS-HC, SymTan, ColdCough HCM, H-C Tussive D, Liquituss HD, Detussin, Zymine HC, Histussin D, Entuss-D Liquid, Histinex D, Procof D, Protuss-D, Hydron KGS, Tussgen, P-V-Tussin, Iotussin D Liquid, Hytussin, De-Chlor MR, Codituss DH, Dolagesic, Pseudatex HC, Entex HC, Maxidone, Hy-Phen, Margesic H, T-Gesic, Dynex HD, Vicotuss, Medtuss HD, KG-Tuss HD, Hydrotussin HD, Spantuss HD, Vanacon, Hytussin Expectorant, Tussafin Liquid, Hydrotropine, Hydrogesic, PhendaCof Plus, Nalex-DH, Phenylephrine HD, Hycomal DH, Dicomal-DH, Codal-DH Syrup, Hyco-DH, Tusdec-HC, Vetuss HC Syrup, Duradyne DHC, Hysingla ER, Duocet, Co-Gesic, Ru-Tuss with Hydrocodone, Rolatuss with Hydrocodone, Entuss-D, Propatuss Expectorant, Enplus-HD, Endal-HD Plus, Exo-Tuss, Comtussin HC, Tuss-HC, Maxi-Tuss SA, Ventuss Syrup, Chemtussin HC, Ditussin-HC, Cyndal HD, Ed-Tuss HC, Chlorgest HD, Hyphen-HD, Tuss-PD, Endotuss-HD, KG-Dal HD, Maxi-Tuss HC, Histinex HC, Hi-Tuss HC, Quindal HD, Quindal HD Plus, Chlorphen HD, Duradal HD, Tussive HC, Liquitussin HC Syrup, Efasin-HD Plus, Tuss-DS, Highland HC, KG-Dal HD Plus, Uni Tuss HC, H-C Tussive, Cytuss HC, Histussin HC Liquid, Iotussin HC, Nasatuss, Tri-Vent HC, Max HC, Excof-SF, Mintex HC, Z-Tuss 2, M-END, Drocon-CS, Donatussin MAX, Excof, Visvex, Bromph HD, Bromplex HD, Bromcomp HC, Brovex HC, J-Tan D HC, SymTan A, Hydrocodone GF, S-T Forte 2, Ed-TLC, Rindal-HD, Iodal HD, Efasin-HD, Guiaphen HD, Chemdal HD Plus, Mintuss MS, Chemdal HD, Endagen-HD, Canges-HC, Vituz, VazoTuss HC, FluTuss HC, BPM PE HC, Canges-HC NR, B-Tuss, Hydron CP, Rindal HPD, Hydro-DP, Hycomine Compound, Gestuss-HC, Dytan-HC, Alor 5/500, D-Tann HC, Hydex PD, EndaCof-Plus, Cytuss-HC NR, Atuss HS, Atuss HD, H-C Tussive-NR, Panasal 5/500, Notuss PD, Zotex HC, Dolacet, Obredon, Codotuss, Co-Tussin, Vi-Q-Tuss, Fentuss Expectorant, Co-Tuss V Expectorant, Endacof XP, Vicoclear, Kwelcof, Anaplex HD, EndaCof-Tab, Maxi-Tuss HCG, Ztuss ZT, Tusso-HC, Pneumotussin HC, Execlear, Cordron-HC NR, Cordron-HC, Liquicough HC, Poly-Tussin HD, Neo HC, Relasin-HC, DroTuss-CP, Maxi-Tuss HCX, Z-Cof HC, Tusana-D, Relacon-HC NR, Hydro-PC II Plus, Atuss MS, De-Chlor HD, Uni-Tricof HC, Rindal HD Plus, Phendal-HD, Echotuss-HC, VasoTuss HC, Notuss-Forte, KG-Tussin, A-G Tussin, Q-V Tussin, P-V-Tussin Syrup, Hydrotuss HC, Hydrocof-HC, Hydron PCS, Tussin-V, Hyphed, Histinex PV, Notuss, Pediatex HC, Tussend, Hexatussin, Welltuss HC, Hycosin 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.

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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