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Hydrocodone use while Breastfeeding

Drugs containing Hydrocodone: Norco, Vicodin, Lortab, Hydrocodone CP, Tussionex Pennkinetic, Hydromet, Vicoprofen, Hysingla ER, Hycodan, Hydrocodone HD, Show all 351 »Lorcet, Zohydro ER, Hycet, Narcof, Anexsia, Vicodin ES, Hydrocet, Hydrocod-GF, Hycomine, Hydrocodone GF, Tussigon, M-END, Vortex, Stagesic, Coughtuss, Histussin HC Syrup, Relasin-HC, Phenylephrine HD, Protuss, Vantrela ER, Lorcet HD, Notuss, Hydrotropine, Lorcet 10/650, Maxidone, Triant-HC, Rindal HPD, MonteFlu HC, Canges-XP, Condasin, Pneumotussin 2.5, H-C Tussive, Vicodin HP, Vanacet, Hy-Phen, Hydrocodone PA Pediatric, CodiCLEAR DH, Fentuss Expectorant, Histex HC, Zutripro, Hydromide, Zydone, Reprexain, VasoTuss HC, Canges-HC, Pancof XP, Novasus, Histinex HC, Highland HC, Lortab ASA, Tussend, Vitussin Expectorant, Zolvit, Tussend Expectorant, Quindal HD, Tussafed-HCG, Dynatuss HC, De-Chlor G, Hydro GP, Donatussin DC, Entuss-D JR, HydroFed, Nazarin HC, Decotuss-HD, Vanex Expectorant, Detussin Expectorant, Tussadur-HD, Nariz HC, Qual-Tussin DC, Simuc-HD, Duratuss HD, Crantex HC, Gentex HC, Levall 5.0, Exetuss-HC, Guiaplex HC, Uni-Lev 5.0, Hydro-Tussin HG, Cotuss V, Hycoclar Tuss, G-Tuss, Hydrotuss, Gua HC, Entuss, Medcodin, Hycoclear, Vicotuss, Hycosin Expectorant, Co-Tussin, Vi-Q-Tuss, Kwelcof, Codotuss, Co-Tuss V Expectorant, Endacof XP, Vicoclear, Pneumotussin, Tusso-DF, Flowtuss, Relasin-HCX, A-Cof DH, S-T Forte, Mintuss G, Ambi 5/15/100, Atuss G, Tussicle, Monte-G HC, Xpect-HC, Touro HC, Execof, Atuss HX, Extendryl HC, Z-Cof HCX, Tussgen Expectorant, Tussafed-HC, Hydropane, Procof, Atuss EX, Entuss Expectorant, Hydron EX, De-Chlor NX, Hydron KGS, KGS-HC, Hy-KXP, Marcof Expectorant, Prolex DH, Codamine Pediatric, Codamine, Poly Hist HC, Hycomine Pediatric, Hycophen, Hypamine, Hycophen Pediatric, Mintuss NX, Protuss-D, Pancof HC, ColdCough HCM, H-C Tussive D, SymTan, Liquituss HD, Zymine HC, Histussin D, Detussin, Entuss-D Liquid, Histinex D, Tussafin, Rezira, Procof D, Tussgen, P-V-Tussin, Iotussin D Liquid, Hytussin, Tussplex, Trimal DH, Hytussin Expectorant, Tussafin Liquid, Su-Tuss HD Elixir, Drituss HD, Hydro-Tuss XP, Pseudatex HC, Entex HC, Dynex HD, Vanacon, Spantuss HD, Poly-Tussin XP, Deconamine CX, Nalex Expectorant, Entuss-D, Hydrotussin HD, Medtuss HD, KG-Tuss HD, Hycofenix, Propatuss Expectorant, Hyco-DH, Dicomal-DH, Hycomal DH, Codal-DH Syrup, Hydrophene DH, Mintuss MR, De-Chlor MR, Codituss DH, PhendaCof Plus, Lortuss HC, Rolatuss with Hydrocodone, Ibudone, Xylon 10, Ru-Tuss with Hydrocodone, Vetuss HC Syrup, Nalex-DH, Tusdec-HC, SRC Expectorant, Hydro-DP, Iodal HD, Chemdal HD, Endagen-HD, Rindal-HD, Ed-TLC, Mintuss MS, Guiaphen HD, Efasin-HD, Vituz, TussiCaps, Tri-Vent HC, Max HC, Excof-SF, Mintex HC, Z-Tuss 2, HyTan, S-T Forte 2, Vanex-HD, Chemdal HD Plus, Exo-Tuss, Chemtussin HC, Ditussin-HC, Endal-HD Plus, Enplus-HD, Ventuss Syrup, Tuss-HC, Comtussin HC, Endotuss-HD, KG-Dal HD, Chlorgest HD, Iotussin HC, Nasatuss, Ed-Tuss HC, Cyndal HD, Tuss-PD, Hyphen-HD, Donatussin MAX, Excof, Zyfrel, Dolagesic, Xodol, Zamicet, Dolacet, Liquicet, Anolor DH5, Theracodophen Low 90, Panacet, Lorcet Plus, Duocet, Co-Gesic, Verdrocet, Duradyne DHC, Hydrogesic, T-Gesic, Margesic H, Azdone, Alor 5/500, Visvex, Bromph HD, Bromplex HD, Bromcomp HC, Endacof HC, J-Tan D HC, SymTan A, Brovex HC, Anaplex HD, Drocon-CS, Tusnel-HC, Damason-P, Panasal 5/500, BPM PE HC, Canges-HC NR, VazoTuss HC, FluTuss HC, Maxi-Tuss SA, Maxi-Tuss HC, Cordron-HC, Hydrocof-HC, Hydron PCS, Cordron-HC NR, Atuss HD, H-C Tussive-NR, Cytuss-HC NR, Atuss HS, Hydrotuss HC, P-V-Tussin Syrup, Hyphed, Hexatussin, Welltuss HC, Tussin-V, Q-V Tussin, KG-Tussin, A-G Tussin, Zotex HC, Codimal DH, EndaCof-Tab, Maxi-Tuss HCG, Obredon, Ztuss ZT, Tusso-HC, Hycotuss Expectorant, Vicodin Tuss, Execlear, D-Tann HC, Dytan-HC, Hydex PD, EndaCof-Plus, Notuss PD, Hycomine Compound, Endal HD, Gestuss-HC, Tussinate, Pediatex HC, JayCof-HC, Tussive HC, Liquitussin HC Syrup, Duradal HD, B-Tuss, Hydro-PC II, De-Chlor HC, De-Chlor HD, Hydron CP, Chlorphen HD, Hi-Tuss HC, Histussin HC Liquid, Uni Tuss HC, KG-Dal HD Plus, Cytuss HC, Tuss-DS, Quindal HD Plus, Efasin-HD Plus, Atuss MS, Hydro-PC II Plus, Maxi-Tuss HCX, Z-Cof HC, DroTuss-CP, Relacon-HC, Notuss-Forte, Histinex PV, Detuss, Liquicough HC, Poly-Tussin HD, Echotuss-HC, Rindal HD Plus, Uni-Tricof HC, Phendal-HD, Relacon-HC NR, Neo HC, Tusana-D, Pneumotussin HC

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.

Drug Levels

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 an estimated 3.1 and 3.7% of the maternal weight-adjusted dosages, but the absolute hydrocodone dosages were 8.58 mcg/kg and 3.07 mcg/kg daily because of the differences in the dosages ingested by their mothers.[1]

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 daily, respectively (range 44.3 to 423.2 mcg/kg daily). 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 daily dosages of hydrocodone were 3.9 and 2.1 mcg/kg, 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.[2]

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.[3] 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.[4] The infant's symptoms were probably due to the maternal opiate use.

Effects on Lactation and Breastmilk

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

Alternate Drugs to Consider

Acetaminophen, Butorphanol, Hydromorphone, Ibuprofen, Morphine

References

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

Hydrocodone Identification

Substance Name

Hydrocodone

CAS Registry Number

125-29-1

Drug Class

Analgesics, Opioid

Narcotics

Antitussive Agents

Administrative Information

LactMed Record Number

359

Last Revision Date

20170411

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