Oxycodone use while Breastfeeding
Drugs containing Oxycodone: Percocet, OxyContin, Roxicodone, Endocet, Percocet 5/325, Roxicet, Percocet 10/325, Tylox, Percodan, Percocet 7.5/325, Show all 35 »
Oxycodone Levels and Effects while Breastfeeding
Summary of Use during Lactation
Maternal use of maximum dosages of oral narcotics while breastfeeding can cause infant drowsiness. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics, particularly in the first week of life. However, the newborn's dosage is limited by the small volumes of colostrum in the first 2 to 3 days postpartum. Once the mother's milk comes in, it is best to limit maternal intake of oral oxycodone (and combinations) and to supplement analgesia with a nonnarcotic analgesic if necessary. A maximum oxycodone dosage of 30 mg daily is suggested. Oxycodone elimination is decreased in young infants and much inter-individual variability exists. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants. 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
Oxycodone is metabolized to the active metabolites, noroxycodone and oxymorphone. Oxycodone has an oral bioavailability of 60% to 87% in adults.[1] Oxycodone elimination is decreased in young infants and much inter-individual variability exists. Oxycodone can be dangerous when used as an analgesic in newborns.[2]
Maternal Levels. Six breastfeeding mothers who were using 1 to 2 capsules containing a combination of 5 mg oxycodone and 500 mg acetaminophen every 4 to 7 hours for post-cesarean section pain had their milk sampled several times after successive doses. Peak oxycodone milk levels reportedly occurred 1 to 2 hours after the first dose and then at variable times after successive doses. The number of hours after a mother's last dose when oxycodone could still be measured in milk was depended on the number of doses taken. Oxycodone could be measured in milk up to 4, 12, and 36 hours after 4, 9, and 11 doses respectively. In all the mothers, measured oxycodone milk levels ranged from undetectable (<5 mcg/L) to 229 mcg/L. The authors estimated that an exclusively breastfed infant would receive a maximum 8% of the maternal weight-adjusted dosage of oxycodone, but active metabolite levels were not measured.[3]
Fifty mothers who delivered by cesarean section and received oxycodone had milk (colostrum) and serum samples measured for oxycodone at 24, 48 and 72 hours postpartum without respect to the time of the previous oxycodone dose. The most common doses received by the mothers during the previous 24 hours (including one 30 mg dose rectally immediately post surgery in some cases) were 60 mg (range 30 to 90 mg), 40 mg (range 0 to 90 mg), and 20 mg (range 0 to 50 mg), respectively. Mean colostrum concentrations at the 3 collection times were 58 mcg/L (range 7 to 130 mcg/L), 49 mcg/L (range 0 to 168 mcg/L), and 35 mcg/L (range 0 to 31 mcg/L), respectively. Little correlation was found between maternal dosage and colostrum concentrations, although colostrum levels correlated well with maternal serum levels, with a colostrum concentrations 3.2 to 3.4 higher than serum. Ten mothers had colostrum oxycodone concentrations over 100 mcg/L and 5 had detectable oxycodone in milk 37 hours after the last dose.[4]
Infant Levels. In a study of 50 mothers taking oxycodone post-cesarean section, 45 blood samples were taken from 41 breastfed infants at 24, 48 or 72 hours postpartum. Only 1 of the samples had a detectable (>2 mcg/L) oxycodone level of 7.4 mcg/L. Because these infants were in the first 3 days postpartum, their dose was probably limited by the small volumes of colostrum they were ingesting.[4]
Effects in Breastfed Infants
A 10-month-old, 7.7 kg infant of a prescription drug-dependant mother died of cardiac arrest after a 12- to 24-hour period of lethargy, hypersomnolence and dyspnea. The infant also had a recent history of fever. The mother had reportedly been breastfeeding the infant 3 times a day for several weeks and had taken 180 mg of oxycodone, as well as muscle relaxants, the day prior to her infant's death. A blood oxycodone level of 600 mcg/L was measured on autopsy. The medical examiner considered it unlikely that such a high level of oxycodone in the infant's blood could be due to breastfeeding exposure as reported by the mother and thus considered the death a homicide resulting from either the intentional administration of oxycodone directly to the infant or from a higher dose of oxycodone in breastmilk than that reported by the mother.[5]
In a study of 50 mothers taking oxycodone post-cesarean section, 50 neonates were evaluated for sedation ever 24 hours after birth. None was severely sedated and less than 4% had sedation of 3 on a 1 to 5 scale. Because these infants were in the first 3 days postpartum, their oxycodone dose was probably limited by the small volumes of colostrum they were ingesting.[4]
A case-control study of 66 women taking oxycodone after a Cesarean section compared mothers of excessively sedated infants to those who were not sedated. The mothers of sedated infants were taking an average dose of 0.87 mg/kg daily and the mothers of nonsedated infants were taking 0.27 mg/kg daily. The sedated infants also slept longer during the night than the control infants (8.3 vs 4.9 hours).[6]
Possible Effects on Lactation
Oxycodone can increase serum prolactin.[7] 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. Baselt RC. Disposition of toxic drugs and chemicals in man. 6th ed. Foster City: Biomedical Publications, 2002:787-9.
2. Pokela ML, Anttila E, Seppala T et al. Marked variation in oxycodone pharmacokinetics in infants. Paediatr Anaesth. 2005;15:560-5. PMID: 15960639
3. Marx CM, Pucino F, Carlson JD et al. Oxycodone excretion in human milk in the puerperium. Drug Intell Clin Pharm. 1986;20:474. Abstract.
4. Seaton S, Reeves M, McLean S. Oxycodone as a component of multimodal analgesia for lactating mothers after Caesarean section: Relationships between maternal plasma, breast milk and neonatal plasma levels. Aust N Z J Obstet Gynaecol. 2007;47:181-5. PMID: 17550483
5. Levine B, Moore KA, Aronica-Pollak P et al. Oxycodone intoxication in an infant: accidental or intentional exposure? J Forensic Sci. 2004;49:1358-60. PMID: 15568714
6. Kelly LE, Madadi P, Wurman C et al. Neonatal CNS depression and maternal oxycodone use during lactation: a case-control study. J Clin Pharmacol. 2010;50:60. Abstract.
7. Saarialho-Kere U, Mattila MJ, Seppala T. Psychomotor, respiratory and neuroendocrinological effects of a mu-opioid receptor agonist (oxycodone) in healthy volunteers. Pharmacol Toxicol. 1989;65:252-7. PMID: 2555803
Oxycodone Identification
Substance Name
CAS Registry Number
76-42-6
Drug Class
- Analgesics, Opioid
- Narcotics
- Antitussive Agents
- Opiates
Administrative Information
LactMed Record Number
378
Information from the National Library of Medicine's LactMed Database.
Last Revision Date
2010-12-07
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...
- Oxycodone use during Pregnancy
- Oxycodone Consumer Information
- Breastfeeding Support Group
- Safe Medications during Breastfeeding
- Medicine use while Breastfeeding
- Medicine use during Pregnancy
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.
