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