Home → Drugs by Condition → P → Pain → Methadone → Breastfeeding

Print Save or Share

Methadone use while Breastfeeding

Drugs containing Methadone: Dolophine, Methadose, Methadone Diskets

Methadone Levels and Effects while Breastfeeding

Summary of Use during Lactation

Expert opinion holds that women who received methadone maintenance during pregnancy and are stable, should be encouraged to breastfeed their infants postpartum.[1][2] In this setting, breastfeeding may decrease neonatal withdrawal symptoms in infants who were exposed in utero. However, a breastfed newborn may require additional treatment for withdrawal.[3][4][5][6][7][8] The amount of methadone in breastmilk from a mother on methadone maintenance was calculated to be insufficient to warrant lowering the dosage of diluted tincture of opium given to the newborn to mitigate methadone withdrawal.[9] The breastfeeding rate among mothers taking methadone for opiate addiction may be lower than in other mothers.

Initiation of methadone postpartum, or increasing the maternal dosage to greater than 100 mg daily therapeutically or by abuse while breastfeeding poses a greater risk of sedation and respiratory depression in the breastfed infant. If the baby shows signs of increased sleepiness (more than usual), breathing difficulties, or limpness, a physician should be contacted immediately.

Drug Levels

Methadone is metabolized to inactive pyrrolidine and pyrroline metabolites. In adults, methadone oral bioavailability is 80 to 95%.[10] In newborns of opiate-dependent mothers, methadone is used to treat neonatal abstinence syndrome. The usual infant dose is 50 to 100 mcg/kg given every 6 to 12 hours.[11]

Maternal Levels. One mother taking 50 mg daily of oral methadone maintenance had milk sampled several times on postpartum days 4 through 8. The highest methadone breastmilk levels (100 and 120 mcg/L) were measured 4 hours after a dose. At 6 and 15 hours after a dose, the level was 40 mcg/L. Lower milk levels (20 and 30 mcg/L) were measured 0 to 3 hours after a dose.[12] Using the peak milk level from this study, an exclusively breastfed infant would receive 18 mcg/kg daily, equal to about 2% of the maternal weight-adjusted dosage.

Ten mothers who were 3 to 10 days postpartum and taking oral methadone maintenance 10 to 80 mg once daily had single milk samples that contained methadone levels ranging from 50 to 570 mcg/L.[13] Using the peak level from this study, an exclusively breastfed infant would receive a maximum of 86 mcg/kg daily of methadone, equal to about 6% of the maternal weight-adjusted dosage.

One mother taking 25 mg daily of oral methadone maintenance had breastmilk sampled twice on postpartum days 5 and 6. The peak methadone milk level was 70 mcg/L on both days, occurring 6 and 3 hours after the dose on postpartum days 5 and 6, respectively. Other reported levels were 50 mcg/L 3 hours after the dose on day 5, and 10 mcg/L just prior to the dose on day 6.[14] Using the peak milk level from this study, an exclusively breastfed infant would receive about 10.5 mcg/kg daily, equal to 2.5% of the maternal weight-adjusted dosage.

One lactating mother taking oral methadone maintenance 45 mg daily had milk sampled several times over the first 4 weeks postpartum and again several times over 24 hours at 6 weeks postpartum. Her colostrum methadone level was 77 mcg/L on the day of delivery and milk levels remained fairly constant (range 77 to 123 mcg/L) throughout the study period. There was little difference in milk levels before and after feeding. Peak milk levels occurred 4 to 6 hours after a dose.[15] Using the range of milk levels reported in this study, an exclusively breastfed infant would receive a maximum of about 12 to 18 mcg/kg daily, equal to 1.6 to 2.4% of the maternal weight-adjusted dosage.

Two mothers, one at 1 week and the other at 3 weeks postpartum, taking oral methadone maintenance (average 0.5 mg/kg daily), had milk levels sampled 4 to 6 times over 8 to 10 hours after a dose. Peak levels were 30 mcg/L and 70 mcg/L, and occurred 1 and 2 hours after the dose, respectively. The half-life of methadone elimination from milk over the collection period was about 8 to 10 hours in both mothers.[16] Using the milk levels reported in this study, calculated average milk levels are about 21 mcg/L and 58 mcg/L, respectively. Using these calculated average milk levels, an exclusively breastfed infant would receive about 3 to 8 mcg/kg daily of methadone, equal to 0.6 to 1.6 % of the maternal weight-adjusted dosage.

Twelve breastfeeding mothers, 11 of whom were 3 to 7 days postpartum and 1 who was 26 days postpartum, were taking daily oral methadone maintenance (range 20 to 80 mg daily) and had their milk sampled once before and once after breastfeeding their infants. Milk sampling occurred 2 to 4 hours after a methadone dose. Levels after the feeding tended to be higher than those before. Milk levels tended to be higher with higher maternal doses. The reported average milk level from all 12 mothers was 116 mcg/L (range 39 to 232 mcg/L). Using this average milk level, the authors calculated an average infant dose from breastmilk of 17.4 mcg/kg daily (range 5.9 to 34.8 mcg/kg daily) and an average maternal weight-adjusted dosage of 2.8% (range 1.4 to 5.1%).[18]

Eight breastfeeding mothers who were 3 weeks to 6 months postpartum and taking an average daily dosage of 102 mg of oral methadone maintenance (range 25 to 180 mg) divided twice daily during pregnancy and lactation had their milk sampled 1 to 3 times at 1 to 8 hours after a dose. The reported average milk level of all the samples from all the mothers in this study was 95 mcg/L (range 27 to 260 mcg/L). Milk levels were reportedly not related to methadone dose, but the exact timing of maternal dose and milk levels was not reported. The maximum level reported in this study occurred in a mother taking 55 mg twice daily at 110 days postpartum.[19] Using the maximum milk level reported in this study, an exclusively breastfed infant would receive about 39 mcg/kg daily, equal to about 2% of the maternal weight-adjusted dosage.

Nine breastfeeding mothers taking 22 to 230 mg of daily oral methadone maintenance had their milk sampled prior to their daily dose and at several times 1 to 23 hours after the dose. Peak levels appeared to occur 2 hours after the dose. A calculated maximum infant intake of 200 mcg/kg daily was reported. The age of the infants, the individual maternal methadone doses and methadone milk levels were not reported.[20]

Eight breastfeeding mothers who were 1 to 11 days postpartum and taking 40 to 105 mg of oral methadone maintenance once daily during pregnancy and lactation had their milk sampled 6 times over 24 hours after a dose. Average milk levels in each mother were calculated from their multiple samples. The average milk level of all 8 mothers was 237 mcg/L (range 68 to 385 mcg/L). Using each of the mother's average milk level, the authors calculated an average maternal weight-adjusted dosage of 2.8%. Two of these mothers had repeat milk sampling at 18 and 27 days postpartum. Each was taking 75 mg daily of methadone. Their average milk levels were 254 and 165 mcg/L with an average maternal weight-adjusted dosage of 2.35 and 1.75%, respectively.[21]

Twelve mothers who were taking oral methadone maintenance during pregnancy and postpartum had their milk tested. Each mother collected pre- and post-feed samples by pump or hand expression just before and 3 hours after the daily methadone dose for each of the first 4 days postpartum. Their average methadone dose at delivery was 76 mg daily (range 40 to 100 mg daily). Average pre-feed trough milk levels ranged from 76 to 102 mcg/L; average post-feed trough levels ranged from 65 to 115 mcg/L. Average pre-feed peak milk levels ranged from 128 to 166 mcg/L; average post-feed peak levels ranged from 123 to 200 mcg/L. No relationship was found between maternal dose and milk levels. The authors calculated that an exclusively breastfed infant would receive the following average doses of methadone: 0.006 mg on day 1 postpartum, 0.018 mg on day 2 postpartum, 0.039 mg on day 3 postpartum and 0.084 mg on day 4 postpartum.[7] In a further analysis, 4 women were followed for 90 to 120 days postpartum. No increase in milk concentrations or infant dosage were noted over time, with an average infant intake calculated to be less than 0.33 mg daily.[22]

Twenty women who were taking methadone in daily dosages averaging 102 mg (range 40 to 200 mg) had methadone measured in milk samples 1 to 6 days postpartum; 16 of the 20 samples were taken between 1 and 4 hours after a dose at the approximate time of peak milk levels. The authors estimated that the maximum amount that a fully breastfed infant would receive is 20 mcg/kg daily (range 4 to 99) of R-methadone and 13 mcg/kg daily (range 2 to 71) of S-methadone in breastmilk. These amounts were 2.7% and 1.6% of the maternal weight-adjusted dosages of the 2 isomers.[23]

Eight mothers who were receiving methadone maintenance in a median dose of 70 mg daily (range 50 to 105 mg daily)obtained paired fore- and hind- breastmilk samples at the times of peak and trough concentrations daily (4 samples daily)on days 1, 2, 3, 4, 14, and 30 after delivery. Breastmilk methadone concentrations increased over the first 14 days from an average of 61 mcg/L on day 2 to 137 mcg/L on day 14 and then stabilized. On each day, postfeed samples had slightly higher methadone concentrations than prefeed samples. The average methadone intake for the breastfeeding infants was estimated at <0.2 mg daily on day 30.[24]

Three women were taking methadone for narcotic abstinence in doses of 70, 40 and 30 mg daily. Methadone milk concentrations measured before and 4 hours after the doses were in the range of 32 to 146 mcg/L with much lower amounts of the two major methadone metabolites, EDDP and EMDP.[25]

Three women were taking methadone during pregnancy and postpartum. Milk samples were obtained from each of them right before a dose and then between 4 and 22 hours after a dose on different days during the postpartum period (exact times not specified). The first woman who was taking 70 mg daily had methadone milk levels ranging between 69 and 146 mcg/L; the second woman was taking 40 mg daily had milk levels between 32 and 170 mcg/L; the third woman who was taking 30 mg daily had milk levels ranging between 59 and 108 mcg/L. Peak milk levels occurred between 4 and 8 hours after the methadone dose in all women.[26]

Infant Levels. The 4-week-old infant of a breastfeeding mother taking 45 mg of oral methadone maintenance a day had undetectable (<0.3 mcg/L) serum levels throughout the first 4 weeks of life.[15]

Three 3- to 7-day-old term infants of mothers taking daily oral methadone maintenance (range 20 to 80 mg daily) had their blood drawn shortly after breastfeeding. Methadone was undetectable in 2 of the infants (<5 mcg/L) and 6.5 mcg/L in 1 infant.[18]

Eight breastfed and 8 formula-fed newborn infants whose mothers were receiving methadone maintenance in a median dose of 70 mg daily (range 50 to 105 mg daily) had methadone measured in their plasma on day 14 of life. Concentrations ranged from 2.2 to 8.1 mcg/L compared with maternal plasma concentrations ranging from 134 to 939 mcg/L. No correlation was found between the infant plasma concentrations and their mother's methadone dosage, their breastfeeding status, or whether the infant received treatment for neonatal abstinence syndrome.[24]

A 1-year-old infant who was breastfed only at bedtime had a serum concentration of 2 mcg/L at 12 hours after breastfeeding. Maternal methadone dosage was not specified.[22]

In summary, most of the case reports and controlled studies of methadone in breastmilk indicate that an infant receives an estimated dose of methadone ranging from 1 to 3% of the mother's weight-adjusted methadone dosage. A minority of studies report a 5 to 6% maternal weight-adjusted methadone dosage. Limited data indicate that serum levels of methadone in breastfed infants are low and that breastfeeding does not appear to add substantially to serum methadone concentrations of infants born to mothers receiving methadone maintenance.

Effects in Breastfed Infants

One center reported 10 women who breastfed during methadone maintenance with no adverse results.[13]

The death of a 5-week-old infant who was born 1 week prematurely to a former heroin-abusing mother was possibly related to methadone in breastmilk. The infant had been breastfeeding since birth and the mother was taking an unreported daily dose of oral methadone maintenance. The medical examiner's diagnosis was methadone intoxication. A high level of methadone was found in the infant's serum at autopsy. The infant was also noted to be "obviously malnourished." Abnormal brain, liver and other organs on autopsy were also found and it appeared that the infant had been neglected.[27][28]

Three breastfed term infants of mothers taking oral methadone maintenance 45 to 70 mg daily during pregnancy and lactation had no reported adverse effects. They were cared for in a well-baby nursery after birth and discharged in good health home with their mothers at 2 to 3 days of age. At follow up over 3 weeks to 6 months of age, the infants had no symptoms of sedation or methadone withdrawal while breastfeeding. One infant who had breastfeeding discontinued at 3 weeks of age developed withdrawal symptoms of hyperirritability and sleeplessness. The other 2 infants were slowly weaned over 4 to 6 months and did not experience withdrawal upon breastfeeding discontinuation. The authors recommended breastfeeding during maternal methadone maintenance to both augment mother-infant bonding and to prevent infant methadone withdrawal. They also cautioned against abrupt breastfeeding discontinuation.[15]

A partially breastfed 3.5-month-old infant of a mother taking oral methadone maintenance 73 mg once daily died of sudden infant death syndrome. The mother was reportedly mostly bottle feeding the infant due to diminished milk supply. There was no methadone detected in the infant's blood at autopsy (lower limit of the assay not reported).[17]

Twelve term breastfed (extent not stated) newborns of mothers taking oral methadone maintenance (range 20 to 80 mg daily) during pregnancy and lactation were observed during their first week of age. Seven of these infants developed methadone withdrawal and 6 required treatment. The authors considered maternal methadone maintenance to be compatible with breastfeeding in the first week of a newborn's life but cautioned that newborn methadone withdrawal may occur despite breastfeeding.[18]

The hospital course of 88 breastfed newborns were compared to 32 non-breastfed newborns. All had mothers taking oral methadone maintenance at an average dose of 40 mg daily (range 5 to 175 mg daily). Although the breastfed newborns developed neonatal abstinence syndrome and required rehospitalization after discharge at the same rate as bottle-fed infants, they did have a shorter hospital stay than bottle-fed newborns.[5] These authors endorse encouraging mothers on methadone maintenance to breastfeed.[29]

Two fully breastfed term infants of mothers taking oral methadone maintenance 70 and 130 mg daily during pregnancy and lactation had no adverse effects and required no treatment for methadone withdrawal prior to postpartum hospital discharge at 8 and 6 days of age, respectively. Both infants were rehospitalized and treated for methadone withdrawal symptoms at 6 weeks and 17 days of age, respectively, shortly after their mothers abruptly discontinued breastfeeding. The authors surmised that the appearance of symptoms were probably due to withdrawal from methadone in breastmilk.[29]

The breastfed infants of an unreported number of mothers taking more than 80 mg daily of oral methadone maintenance during pregnancy and lactation did not experience withdrawal and did not require additional care for complications due to exposure to methadone. Based on these experiences at their institution, the author recommended encouraging breastfeeding in mothers taking high dosages of methadone maintenance during pregnancy and lactation.[4]

A comparison of 16 bottle- and breastfed newborns of mothers taking 30 to 100 mg of daily oral methadone maintenance during pregnancy and postpartum found that the exclusively breastfed infants had a lower requirement for treatment of methadone withdrawal symptoms and a shorter length of hospital stay compared to partially breastfed or bottle-fed newborns. The maternal methadone doses in the 2 groups of newborns was not reported.[30]

Successful breastfeeding was reported in New Zealand in 15 infants whose mothers were taking methadone for pain and 18 infants whose mothers were taking methadone for maintenance of narcotic abstinence. Both groups of mothers were taking a wide range of doses with median daily dosages of 40 and 60 mg, respectively. An additional 8 infants were bottle-fed and the feeding method was unknown in 2, but no indication was given that adverse reactions had occurred in any of these infants.[31]

A Swiss report found that among the newborns of mothers on methadone maintenance, the neonatal abstinence syndrome was less frequent in breastfed infants than in non-breastfed infants, 26% and 78%, respectively. Twenty-seven infants were breastfed and 54 were formula-fed. "Breastfed" was defined by the authors as more than 50% of feeding from breastmilk while in the hospital.[32]

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 methadone and a hydrocodone-acetaminophen combination product that had been prescribed for migraine headache before she was breastfeeding.[33]

A retrospective review was conducted on the medical records of 190 drug-dependent mothers and their infants. One hundred forty-nine of the mothers were taking methadone at delivery; 62 mothers taking methadone (average dose 68.5 mg daily; maximum dose 150 mg daily) breastfed their infants and 87 mothers taking methadone (average dose 79.6 mg daily) formula-fed their infants. Breastfed infants had a longer median time to withdrawal symptoms (10 days) than formula-fed infants (3 days). Breastfed infants were less likely to require pharmacologic treatment and doses of morphine required to treat withdrawal were lower in breastfed infants. Treatment duration was also shorter in breastfed infants (85 vs. 108 days).[34]

A hospital in England reported outcomes among infants whose mothers were taking methadone maintenance during pregnancy over 2 time periods. Several changes were made in the management of mothers taking methadone between the 2 time periods. In the first time period (1991-1994), only 10% breastfed their infants (4% exclusive); in the second time period (1997-2001), 30% breastfed their infants (20% exclusive). During the second time period, the frequency of jaundice, and convulsions were less frequent in all infants, even though the average maternal methadone dose was twice as high as in the earlier period. Pharmacologic treatment of the infants for withdrawal, days of hospitalization, days in intensive care, and percentage of infants admitted to intensive care were all lower during the second time period.[35]

Eight breastfed and 8 formula-fed newborn infants whose mothers were receiving methadone maintenance in a median dose of 70 mg daily (range 50 to 105 mg daily). No differences were noted between infants in the 2 groups on days 3, 14 or 30 in 9 neurobehavioral measures.[24]

Four breastfed infants whose mothers were on methadone maintenance (dosage not specified) were followed for 6 months. No health concerns arose during this time. Another infant who was partially breastfed for 1 year had no important health or developmental problems during this time.[22]

A retrospective review of the charts of 68 newborn infants exposed to methadone in utero found that infants who were breastfed had a trend towards requiring shorter durations of treatment for neonatal abstinence syndrome, although the trend was not statistically significant.[36]

A retrospective study reviewed the records of 437 newborn infants whose mothers were taking methadone maintenance therapy. Infants who were breastfed for 72 or more hours had a 45% reduced risk of experiencing neonatal abstinence syndrome compared to those who were not. Neonatal abstinence syndrome was more likely in mothers who were also receiving a benzodiazepine.[37]

A 13-month-old infant was being primarily breastfed by a mother who was taking hydrocodone and acetaminophen for pain. On 2 occasions 4 hours apart, she substituted a dose of 40 mg of methadone for the acetaminophen-hydrocodone combination. The child nursed 2 and 6 hours after the second dose for 45 minutes each time, then fell asleep for 45 minutes. Forty-five minutes later, the infant's mother noted that the infant was drowsy and not responsive. Emergency responders confirmed that the baby had cyanosis, myosis, and decreased breathing. Upon arrival at the emergency room, the child was unarousable, but had normal vital signs. The baby awoke after naloxone 0.2 mg was given intravenously. The infant's urine drug screen was positive for opiates, including methadone metabolites. Eighteen hours after the mother's first dose, the infant remained intermittently drowsy with oxygen saturation dropping as low as 91%. During this 18-hour time period, the infant had received 4 doses of naloxone intravenously. Eventually, the baby returned to normal state of good health.[38]

A retrospective study of 128 infants exposed during pregnancy and breastfeeding to methadone found an inverse relationship between the amount of breastfeeding and duration of hospitalization for neonatal abstinence syndrome. Five of the breastfed infants were readmitted for withdrawal symptoms after discontinuing or markedly reducing breastmilk intake after discharge.[39]

Possible Effects on Lactation

Methadone can increase serum prolactin.[40] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.

In a multicenter prospective study of 246 pregnant women receiving either methadone or buprenorphine for opiate addiction, 93 women were receiving methadone. Twenty-four percent of women receiving methadone breastfed their infants, which was not different from those receiving buprenorphine.[41]

A woman who was not breastfeeding, but who had 2 children (breastfeeding history not stated), was prescribed methadone 30 mg daily for heroin addiction. When the dose was increased to 40 mg daily, she developed galactorrhea. Her serum prolactin levels were elevated on 3 occasions over the next year, but all other examinations were normal. Galactorrhea and amenorrhea persisted for at least 2 years with continuous methadone use. The authors of the article stated that 3 cases of hyperprolactinemia had been reported to the United Kingdom's drug regulatory agency. Causality was not proven in any of these cases.[42]

A case series of opiate-dependent mothers who delivered in a Baby Friendly Hospital found that mothers taking methadone or buprenorphine for opiate addiction were unlikely to breastfeed their infants. Only 27% of the 132 mothers on methadone maintenance initiated breastfeeding. Of all women in the study, 60% discontinued breastfeeding before discharge from the hospital.[43]

Alternate Drugs to Consider

(Analgesia) Morphine, (Narcotic Abstinence) Buprenorphine, Naltrexone

References

1. Jansson LM. ABM Clinical Protocol #21: Guidelines for breastfeeding and the drug-dependent woman. Breastfeed Med. 2009;4:225-8. PMID: 19835481

2. Wong S, Ordean A, Kahan M. Substance use in pregnancy. J Obstet Gynaecol Can. 2011;33:367-84. PMID: 21501542

3. Philipp BL, Merewood A, O'Brien S. Methadone and breastfeeding: new horizons. Pediatrics. 2003;111:1429-30. PMID: 12777563

4. Fong G. High doses of methadone in breastfeeding. Presented at the ASHP Annual Meeting. 2000;57:pp. INTL-3. IPA accession number 37-05332

5. Malpas TJ, Horwood J, Darlow BA. Breastfeeding reduces the severity of neonatal abstinence syndrome. J Paediatr Child Health. 1997;33:A38. Abstract P20.

6. Oei J, Lui K. Management of the newborn infant affected by maternal opiates and other drugs of dependency. J Paediatr Child Health. 2007;43:9-18. PMID: 17207049

7. Jansson LM, Choo RE, Harrow C et al. Concentrations of methadone in breast milk and plasma in the immediate perinatal period. J Hum Lact. 2007;23:184-90. PMID: 17478871

8. Loustauneau A, Auriacombe M, Daulouede JP, Tignol J . [Is buprenorphine a potential alternative to methadone for treating pregnant drug users? Inventory of clinical data in the literature]. Ann Med Interne (Paris). 2002;153 (7 Suppl):2S31-6. PMID: 12518080

9. Meites E . Opiate exposure in breastfeeding newborns. J Hum Lact. 2007;23:13. Letter. PMID: 17293546

10. Dole VP. Implications of methadone maintenance for theories of narcotic addiction. JAMA. 1988;260:3025-9. PMID: 2846900

11. American Academy of Pediatrics Committee on Drugs. Neonatal drug withdrawal. Pediatrics. 1998;101:1079-88. PMID: 9614425

12. Kreek MJ, Schecter A, Gutjahr CL et al. Analyses of methadone and other drugs in maternal and neonatal body fluids: Use in evaluation of symptoms in a neonate of mother. Am J Drug Alcohol Abuse. 1974;1:409-19. PMID: 4619541

13. Blinick G, Inturrisi CE, Jerez E et al. Methadone assays in pregnant women and progeny. Am J Obstet Gynecol. 1975; 121:617-21. PMID: 1115163

14. Kreek MJ. Methadone disposition during perinatal period in humans. Pharmcol Biochem Behavior. 1979;11 (Suppl):7-13. PMID: 550136

15. Robinson JS, Catlin DH, Barrett CT. Withdrawal from methadone by breast feeding. In: Stern L et al., eds. Intensive care in the Newborn, III. Masson. 1979;213-8.

16. Pond SM, Kreek MJ, Tong TG et al. Altered methadone pharmacokinetics in methadone-maintained pregnant women. J Pharmacol Exp Ther. 1985;233:1-6. PMID: 3981450

17. Geraghty B, Graham EA, Logan B et al. Methadone levels in breast milk. J Hum Lact. 1997;13:227-30. PMID: 9341416

18. Wojnar-Horton RE, Kristensen JH, Yapp P et al. Methadone distribution and excretion into breast milk of clients in a methadone maintenance programme. Br J Clin Pharmacol. 1997;44:543-7. PMID: 9431829

19. McCarthy JJ, Posey BL. Methadone levels in human milk. J Hum Lact. 2000;16:115-20. PMID: 11153342

20. Ho T, Selby P, Kapur B, Ito S. Pharmacokinetics of methadone in breast milk. Clin Pharmacol Ther. 2001;69:P51. Abstract PII-73.

21. Begg EJ, Malpas TJ, Hackett LP et al. Distribution of R- and S-methadone into human milk during multiple, medium to high oral dosing. Br J Clin Pharmacol. 2001;52:681-85. PMID: 11736879

22. Jansson LM, Choo R, Velex ML et al. Methadone maintenance and long-term lactation. Breastfeed Med. 2008;3:34-7.

23. Bogen DL, Perel JM, Helsel JC et al. Estimated infant exposure to enantiomer-specific methadone levels in breastmilk. Breastfeed Med. 2011. PMID: 21348770

24. Jansson LM, Choo R, Velez ML et al. Methadone maintenance and breastfeeding in the neonatal period. Pediatrics. 2008;121:106-14. PMID: 18166563

25. Nikolaou PD, Papoutsis II, Maravelias CP et al. Development and validation of an EI-GC-MS method for the determination of methadone and its major metabolites (EDDP and EMDP) in human breast milk. J Anal Toxicol. 2008;32:478-84. PMID: 18713515

26. Nikolaou P, Papoutsis I, Atta-Politou J et al. Monitoring methadone milk concentrations of methadone-maintained women in postpartum period for breastfeeding safety. Toxicol Lett. 2009;189 (Sp. Iss. Si):S264. Abstract.

27. Smialek JE, Monforte JR, Aronow R et al. Methadone deaths in children: a continuing problem. JAMA. 1977;238:2516-7. PMID: 578886

28. Smialek JE, Monforte JR. Toxicology and sudden infant death. J Forensic Sci. 1977;22:757-62. PMID: 618000

29. Malpas TJ, Darlow BA. Neonatal abstinence syndrome following abrupt cessation of breastfeeding. N Z Med J. 1999;112:12-3. PMID: 10073159

30. Ballard JL, D'Apolito K. Shortened length of stay for neonatal abstinence syndrome from methadone using mother's milk as therapy. Pediatr Res 2001;49(4 Pt 25 Suppl):354A. Abstract.

31. Sharpe C, Kuschel C. Outcomes of infants born to mothers receiving methadone for pain management in pregnancy. Arch Dis Child Fetal Neonatal Ed. 2004;89:F33-6. PMID: 14711851

32. Arlettaz R, Kashiwagi M, Das-Kundu S et al. Methadone maintenance program in pregnancy in a Swiss perinatal center (II): neonatal outcome and social resources. Acta Obstet Gynecol Scand. 2005;84:145-50. PMID: 15683374

33. 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

34. Abdel-Latif ME, Pinner J, Clews S et al. Effects of breast milk on the severity and outcome of neonatal abstinence syndrome among infants of drug-dependent mothers. Pediatrics. 2006;117:e1163-9. PMID: 16740817

35. Miles J, Sugumar K, Macrory F et al. Methadone-exposed newborn infants: outcome after alterations to a service for mothers and infants. Child Care Health Dev. 2007;33:206-12. PMID: 17291325

36. Lim S, Prasad MR, Samuels P et al. High-dose methadone in pregnant women and its effect on duration of neonatal abstinence syndrome. Am J Obstet Gynecol. 2009;200:70.e1-5. PMID: 18976737

37. Dryden C, Young D, Hepburn M, Mactier H. Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources. BJOG. 2009. PMID: 19220239

38. West PL, Mckeown NJ, Hendrickson RG. Methadone overdose in a breast-beeding toddler. Clin Toxicol. 2009;47:95. Abstract.

39. Isemann B, Meinzen-Derr J, Akinbi H . Maternal and neonatal factors impacting response to methadone therapy in infants treated for neonatal abstinence syndrome. J Perinatol. 2011;31:25-9. PMID: 20508596

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

41. Lejeune C, Aubisson S, Simmat-Durand L et al. [Withdrawal syndromes of newborns of pregnant drug abusers maintained under methadone or high-dose buprenorphine: 246 cases]. Ann Med Interne (Paris). 2001;152 (Suppl 7):21-7. PMID: 11965095

42. Bennett J, Whale R. Galactorrhoea may be associated with methadone use. BMJ. 2006;332:1071. PMID: 16675813

43. Wachman EM, Byun J, Philipp BL. Breastfeeding rates among mothers of infants with neonatal abstinence syndrome. Breastfeed Med. 2010;5:159-64. PMID: 20658895

Methadone Identification

Substance Name

Methadone

CAS Registry Number

76-99-3

Drug Class

  • Analgesics, Opioid
  • Narcotics
  • Antitussive Agents

Administrative Information

LactMed Record Number

367

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

Last Revision Date

2011-06-02

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.

Advertisement
Close

Recommended

(web4)