Hydrocodone use while Breastfeeding
Drugs containing Hydrocodone: Norco, Vicodin, Lortab, Hydrocodone CP, Tussionex Pennkinetic, Hydromet, Hydrocodone HD, Vicoprofen, Hysingla ER, Hycodan, Show all 351 »Lorcet, Zohydro ER, Vicodin ES, Hycet, Anexsia, Condasin, Narcof, Ibudone, Vortex, Reprexain, Vicodin HP, Phenylephrine HD, Triant-HC, Coughtuss, Hydrocet, Zutripro, Novasus, Hydron PCS, Hydrocod-GF, Flowtuss, MonteFlu HC, Tussigon, Maxidone, Zamicet, Hycomine, Stagesic, Xodol, Lorcet Plus, Lorcet 10/650, Xylon 10, Hydrocodone GF, TussiCaps, Damason-P, Histussin HC Syrup, Hydrocof-HC, Welltuss HC, De-Chlor HC, Relasin-HC, Rezira, Tussinate, Tusso-DF, Pneumotussin, Nalex Expectorant, Hycofenix, Hydromide, Hycotuss Expectorant, CodiCLEAR DH, Marcof Expectorant, Hydrotropine, Prolex DH, Hydrocodone PA Pediatric, Poly Hist HC, Hydro-DP, Rindal HPD, Zydone, Co-Gesic, Lortab ASA, M-END, Zyfrel, Visvex, HydroFed, Nazarin HC, Crantex HC, Entuss-D JR, Liquicet, Nariz HC, Qual-Tussin DC, Donatussin DC, Gentex HC, Guiaplex HC, Decotuss-HD, Exetuss-HC, Duratuss HD, Simuc-HD, Vanex Expectorant, Spantuss HD, Medtuss HD, KG-Tuss HD, Vanacon, Su-Tuss HD Elixir, Drituss HD, Hytussin Expectorant, Tussafin Liquid, Hydrotussin HD, Entuss-D, Detussin Expectorant, Tussend Expectorant, Tussadur-HD, Tussgen Expectorant, SRC Expectorant, Poly-Tussin XP, Deconamine CX, Uni-Lev 5.0, Dynatuss HC, Pancof XP, Execof, Entuss, Touro HC, Xpect-HC, Extendryl HC, Atuss HX, Pneumotussin 2.5, Medcodin, Cotuss V, Hycoclar Tuss, Vitussin Expectorant, Hydrotuss, Hycoclear, Gua HC, Hydro-Tussin HG, Canges-XP, Tussafed-HC, Ambi 5/15/100, Atuss G, Levall 5.0, Hydro GP, Hydro-Tuss XP, De-Chlor G, Mintuss G, Azdone, Monte-G HC, Z-Cof HCX, Tussicle, A-Cof DH, S-T Forte, Relasin-HCX, Tussafed-HCG, Pseudatex HC, Hydron EX, Procof, Atuss EX, De-Chlor NX, Hy-KXP, Hydron KGS, KGS-HC, Entuss Expectorant, Protuss, Codamine Pediatric, Codamine, Verdrocet, Hycomine Pediatric, Hycophen, Hypamine, Hycophen Pediatric, Mintuss NX, Protuss-D, SymTan, Pancof HC, ColdCough HCM, Liquituss HD, Detussin, Zymine HC, Histussin D, H-C Tussive D, Entuss-D Liquid, Tussgen, Tussafin, Procof D, P-V-Tussin, Hytussin, Histinex D, Iotussin D Liquid, Duocet, Tussplex, Hy-Phen, Vantrela ER, Panacet, Lorcet HD, T-Gesic, Rolatuss with Hydrocodone, Margesic H, Vanacet, Hydropane, Anolor DH5, G-Tuss, Entex HC, Theracodophen Low 90, Dolacet, Dolagesic, Zolvit, Ru-Tuss with Hydrocodone, Vetuss HC Syrup, Hydrophene DH, Codal-DH Syrup, Hyco-DH, Codituss DH, De-Chlor MR, Trimal DH, Mintuss MR, Dicomal-DH, Hycomal DH, Tusdec-HC, Hydrogesic, Nalex-DH, Lortuss HC, PhendaCof Plus, Duradyne DHC, Dynex HD, Hycosin Expectorant, H-C Tussive, Uni Tuss HC, Highland HC, Histussin HC Liquid, Cytuss HC, Efasin-HD Plus, Tuss-DS, KG-Dal HD Plus, Histinex HC, Comtussin HC, Enplus-HD, Endal-HD Plus, Tuss-HC, Ventuss Syrup, Maxi-Tuss HC, Maxi-Tuss SA, Quindal HD Plus, Quindal HD, Uni-Tricof HC, Hydro-PC II Plus, Atuss MS, Rindal HD Plus, Echotuss-HC, Relacon-HC NR, Phendal-HD, De-Chlor HD, Hydron CP, Duradal HD, Chlorphen HD, Hi-Tuss HC, Liquitussin HC Syrup, Tussive HC, Hydro-PC II, B-Tuss, Exo-Tuss, Chemtussin HC, SymTan A, J-Tan D HC, Excof, Brovex HC, Endacof HC, Chemdal HD, Endagen-HD, Donatussin MAX, Vituz, Tri-Vent HC, Histex HC, Z-Tuss 2, Max HC, Excof-SF, HyTan, S-T Forte 2, Iodal HD, Rindal-HD, Hyphen-HD, Cyndal HD, Ed-Tuss HC, Tuss-PD, KG-Dal HD, Ditussin-HC, Endotuss-HD, Chlorgest HD, Iotussin HC, Guiaphen HD, Efasin-HD, Ed-TLC, Mintuss MS, Vanex-HD, Nasatuss, Chemdal HD Plus, Tusana-D, Neo HC, BPM PE HC, Canges-HC NR, FluTuss HC, VasoTuss HC, Tusnel-HC, Alor 5/500, Panasal 5/500, VazoTuss HC, Canges-HC, Hycomine Compound, Hydex PD, EndaCof-Plus, Endal HD, Gestuss-HC, D-Tann HC, Dytan-HC, Obredon, Maxi-Tuss HCG, Fentuss Expectorant, Codotuss, Co-Tussin, Co-Tuss V Expectorant, Vicoclear, Mintex HC, Endacof XP, Vi-Q-Tuss, Kwelcof, Tusso-HC, Ztuss ZT, EndaCof-Tab, Execlear, Vicodin Tuss, Propatuss Expectorant, Pneumotussin HC, Notuss PD, Codimal DH, Notuss, Notuss-Forte, Anaplex HD, Detuss, Histinex PV, Pediatex HC, JayCof-HC, Bromplex HD, Bromph HD, DroTuss-CP, Liquicough HC, Poly-Tussin HD, Z-Cof HC, Maxi-Tuss HCX, Bromcomp HC, Relacon-HC, Tussend, Hexatussin, Atuss HS, Atuss HD, Cordron-HC NR, Drocon-CS, Cytuss-HC NR, Zotex HC, H-C Tussive-NR, Cordron-HC, Hydrotuss HC, Tussin-V, Hyphed, Q-V Tussin, A-G Tussin, P-V-Tussin Syrup, KG-Tussin, Vicotuss
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.
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.
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.
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. 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. The infant's symptoms were probably due to the maternal opiate use.
Effects on Lactation and Breastmilk
Narcotics can increase serum prolactin. However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.
Alternate Drugs to Consider
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
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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.
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