Sufentanil use while Breastfeeding

Drugs containing Sufentanil: Sufenta

Sufentanil Levels and Effects while Breastfeeding

Summary of Use during Lactation

When used epidurally or intravenously during labor or for a short time immediately postpartum, amounts of sufentanil ingested by the neonate are small and would not be expected to cause any adverse effects in breastfed infants. Labor pain medication may delay the onset of lactation. Because of sufentanil's long half-life during continued intravenous infusion or repeated intravenous administration,[1] sufentanil levels in milk would be expected to increase if used for an extended period postpartum. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of sufentanil to a few days. Because there is no published experience with repeated doses of intravenous sufentanil during established lactation, other agents may be preferred, especially while nursing a newborn or preterm infant. 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

Sufentanil is metabolized to a minimally active and inactive metabolites. The oral bioavailability of sufentanil is unknown. Therapeutic plasma levels from intravenous sufentanil during surgery in adults are 0.25 to 8 mcg/L. The usual intravenous dosage of sufentanil for anaesthesia in an infant during surgery is 10 to 15 mcg/kg. Lower dosages 0.25 to 1 mcg/kg are used for analgesia. Sufentanil is also commonly administered epidurally. Plasma levels are markedly lower when the epidural route is used.[1]

Maternal Levels. Nine women who had undergone cesarean section received sufentanil 50 mcg epidurally immediately after delivery. Sufentanil was undetectable (<0.1 mcg/L) in colostrum at about 1 hour after the dose.[2]

Twenty-nine women undergoing cesarean section received 20 mcg of epidural sufentanil prior to surgery and were then randomized to receive either an epidural anaesthetic combined with sufentanil 3.75 mcg per hour plus 1.25 mcg every 20 minutes as needed via a patient-controlled epidural analgesia (PCEA) device, or an epidural anaesthetic alone via PCEA with no sufentanil. Breastmilk was sampled on postpartum days 1, 2 and 3. Sufentanil was detected in breastmilk in all groups. Levels were highest in the group receiving postpartum sufentanil via PCEA; however, cumulative sufentanil dosages were not reported. Milk levels were apparently low in the other 2 groups.[3] Reporting errors in this study do not allow for estimation of infant sufentanil dose from milk.

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

Effects in Breastfed Infants

Newborns of breastfeeding mothers who received epidural sufentanil before and after cesarean section delivery were reportedly not clinically affected and had no differences in behavior or clinical signs over 3 days postpartum compared to newborns of mothers who received epidural sufentanil prior to delivery only.[3]

Possible Effects on Lactation

Narcotics can increase serum prolactin.[4][5] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.

A national survey of women and their infants from late pregnancy through 12 months postpartum compared the time of lactogenesis II in mothers who did and did not receive pain medication during labor. Categories of medication were spinal or epidural only, spinal or epidural plus another medication, and other pain medication only. Women who received medications from any of the categories had about twice the risk of having delayed lactogenesis II (>72 hours) compared to women who received no labor pain medication.[6]

Alternate Drugs to Consider

Acetaminophen, Butorphanol, Fentanyl, Hydromorphone, Ibuprofen, Morphine

References

1. Hansdottir V, Woestenborghs R, Nordberg G. The pharmacokinetics of continuous epidural sufentanil and bupivacaine infusion after thoracotomy. Anesth Analg. 1996;83:401-6. PMID: 8694326

2. Madej TH, Strunin L. Comparison of epidural fentanyl with sufentanil. Anaesthesia. 1987;42:1156-61. PMID: 2963561

3. Cuypers L, Wiebalck A, Vertommen JD et al. Epidural sufentanil for postcesarean pain: breast milk levels and effects on the baby. Acta Aneasthiol Belg. 1995;46:104-5.

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

5. Frecska E, Perenyi A, Arato M. Blunted prolactin response to fentanyl in depression. Normalizing effect of partial sleep deprivation. Psychiatry Res. 2003;118:155-64. PMID: 12798980

6. Lind JN, Perrine CG, Li R. Relationship between use of labor pain medications and delayed onset of lactation. J Hum Lact. 2014. PMID: 24451212

Sufentanil Identification

Substance Name

Sufentanil

CAS Registry Number

56030-54-7

Drug Class

  • Analgesics, Opioid
  • Narcotics
  • Anesthetics, Intravenous
  • Opiates

Administrative Information

LactMed Record Number

386

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

Last Revision Date

2014-03-06

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)