Hydromorphone use while Breastfeeding

Drugs containing Hydromorphone: Dilaudid, Exalgo, Hydromorph Contin, Palladone, Dilaudid-HP, Hydrostat IR, Dilaudid Cough Syrup

Hydromorphone Levels and Effects while Breastfeeding

Summary of Use during Lactation

Limited data indicate that hydromorphone is excreted into breastmilk in small amounts. 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 hydromorphone to a few days at a low dosage 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

In adults, hydromorphone has an oral bioavailability of 62% and is metabolized to inactive metabolites. While not commonly used in infants, an appropriate dose for this age group is 10 mcg/kg parenterally or 30 mcg/kg orally every 4 hours as needed.

Maternal Levels. Eight lactating women (time postpartum not given) were given a single 2 mg intranasal dose of hydromorphone. Milk was collected 7 times, beginning 2 hours after and ending 24 hours after the dose. Peak milk levels occurred 2 hours after the dose. The half-life of elimination from milk was 10.5 hours. The reported average milk level, over the 24 hour period after the single dose, was about 1 mcg/L. The authors calculated that an exclusively breastfed infant would receive 0.67% of the maternal weight-adjusted dosage.[1] Using the average milk level reported in this study, an exclusively breastfed infant would receive 0.15 mcg/kg daily from a single maternal 2 mg intranasal hydromorphone dose. Intranasal hydromorphone is not currently available in the United States.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

Possible Effects on Lactation

Narcotics can increase serum prolactin.[2] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.

Alternate Drugs to Consider

Acetaminophen, Ibuprofen, Morphine

References

1. Edwards JE, Rudy AC, Wermeling DP et al. Hydromorphone transfer into breast milk after intranasal administration. Pharmacotherapy. 2003;23:153-8. PMID: 12587803

2. Tolis G, Dent R, Guyda H. Opiates, prolactin, and the dopamine receptor. J Clin Endocrinol Metab. 1978;47:200-3. PMID: 263291

Hydromorphone Identification

Substance Name

Hydromorphone

CAS Registry Number

466-99-9

Drug Class

  • Analgesics, Opioid
  • Narcotics
  • Antitussive Agents
  • Opiates

Administrative Information

LactMed Record Number

360

Information from the National Library of Medicine's LactMed Database.

Last Revision Date

2014-01-16

Disclaimer

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.

See Also...

Disclaimer: This information is not intended as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. Use of this website signifies your agreement to the Terms of Use and Online Privacy Policy.

Hide
(web5)