Hydrocodone use while Breastfeeding
Drugs containing Hydrocodone: Norco, Vicodin, Lortab, Tussionex Pennkinetic, Hycodan, Hydromet, Hysingla ER, Vicoprofen, Lorcet, Zohydro ER, Show all 350 »Narcof, Hycet, Lorcet 10/650, TussiCaps, Vicodin ES, Vicodin HP, Anexsia, Lorcet Plus, Vortex, Tussigon, Hycomine, Stagesic, Ibudone, Triant-HC, Lorcet HD, Histinex HC, Histussin HC Syrup, Maxidone, Hydrocet, Chlorgest HD, Hycophen, Reprexain, Hydropane, Dolacet, Zamicet, Tussend, Hyphed, Histinex PV, Zutripro, Coughtuss, Hydrocodone HD, Relasin-HC, Notuss, Detuss, Hycotuss Expectorant, Nalex Expectorant, Tussafed-HC, Hycofenix, Hydrotropine, Marcof Expectorant, Ambi 5/15/100, Flowtuss, Vicodin Tuss, Obredon, Codituss DH, Kwelcof, Hydrocod-GF, Hydex PD, Rindal HPD, Vanacet, Zolvit, Liquicet, Duocet, Xodol, Nazarin HC, MonteFlu HC, Hycoclar Tuss, HydroFed, Zyfrel, Entuss-D JR, Dolagesic, Nariz HC, Qual-Tussin DC, Simuc-HD, Duratuss HD, Crantex HC, Gentex HC, Donatussin DC, Exetuss-HC, Guiaplex HC, Decotuss-HD, Vanex Expectorant, Medtuss HD, KG-Tuss HD, Hydrotussin HD, Spantuss HD, Vanacon, Tussafin Liquid, Su-Tuss HD Elixir, Entuss-D, Poly-Tussin XP, Tussend Expectorant, Tussadur-HD, G-Tuss, Detussin Expectorant, Tussgen Expectorant, Deconamine CX, SRC Expectorant, Uni-Lev 5.0, Tussafed-HCG, Atuss HX, Xpect-HC, Touro HC, Extendryl HC, Hydro-Tussin HG, Canges-XP, Condasin, Pancof XP, Execof, Medcodin, Hycoclear, Gua HC, Pneumotussin 2.5, Entuss, Tusso-DF, Pneumotussin, Z-Cof HCX, Monte-G HC, Hydro GP, Levall 5.0, Atuss G, De-Chlor G, Dynatuss HC, Cotuss V, Hytussin Expectorant, Mintuss G, Vitussin Expectorant, A-Cof DH, Tussicle, Relasin-HCX, S-T Forte, Theracodophen Low 90, Anolor DH5, Hydrotuss, Dynex HD, Hy-KXP, De-Chlor NX, Hydron EX, KGS-HC, Hydron KGS, Protuss-D, Mintuss NX, Procof, Atuss EX, Hypamine, Hycophen Pediatric, Hycomine Pediatric, Hydrocodone PA Pediatric, Prolex DH, Entuss Expectorant, Protuss, Procof D, Rezira, SymTan, Pancof HC, ColdCough HCM, Liquituss HD, Detussin, Zymine HC, Histussin D, H-C Tussive D, Entuss-D Liquid, Tussgen, Tussafin, P-V-Tussin, Hytussin, Histinex D, Iotussin D Liquid, Codamine Pediatric, Codamine, Duradyne DHC, Hydrogesic, Hydromide, Co-Gesic, Verdrocet, Rolatuss with Hydrocodone, Xylon 10, Margesic H, T-Gesic, Entex HC, Vicotuss, Hydro-Tuss XP, Pseudatex HC, Panacet, Zydone, Hy-Phen, Ru-Tuss with Hydrocodone, Vetuss HC Syrup, De-Chlor MR, Hydrophene DH, Codal-DH Syrup, Mintuss MR, Trimal DH, Poly Hist HC, Tussplex, Hyco-DH, Dicomal-DH, Phenylephrine HD, Tusdec-HC, Nalex-DH, Lortuss HC, Hycomal DH, PhendaCof Plus, Drituss HD, Hycosin Expectorant, KG-Dal HD Plus, Maxi-Tuss HC, Maxi-Tuss SA, Highland HC, Uni Tuss HC, Cytuss HC, Histussin HC Liquid, H-C Tussive, Ventuss Syrup, Tuss-HC, Chemtussin HC, Ditussin-HC, Endotuss-HD, Exo-Tuss, Endal-HD Plus, Comtussin HC, Enplus-HD, Tuss-DS, Efasin-HD Plus, De-Chlor HD, Hydron CP, Hydro-PC II, De-Chlor HC, Atuss MS, Uni-Tricof HC, Hydro-PC II Plus, B-Tuss, Tussive HC, Hi-Tuss HC, Quindal HD, Quindal HD Plus, Chlorphen HD, Duradal HD, Hydrocodone CP, Liquitussin HC Syrup, KG-Dal HD, Tuss-PD, Novasus, HyTan, S-T Forte 2, Vituz, SymTan A, Endacof HC, Brovex HC, Hydrocodone GF, J-Tan D HC, Tri-Vent HC, Max HC, Excof-SF, Histex HC, Mintex HC, Excof, Z-Tuss 2, Bromcomp HC, Visvex, Nasatuss, Chemdal HD Plus, Vanex-HD, Iotussin HC, Ed-Tuss HC, Hyphen-HD, Cyndal HD, Mintuss MS, Guiaphen HD, Chemdal HD, Endagen-HD, Bromph HD, Iodal HD, Rindal-HD, Efasin-HD, Ed-TLC, Rindal HD Plus, Echotuss-HC, D-Tann HC, Dytan-HC, Gestuss-HC, BPM PE HC, VasoTuss HC, Damason-P, Lortab ASA, Tusnel-HC, Tussinate, Endal HD, Codimal DH, Zotex HC, Canges-HC NR, Notuss PD, EndaCof-Plus, Hydro-DP, Hycomine Compound, Panasal 5/500, Alor 5/500, Codotuss, Co-Tussin, Vi-Q-Tuss, Fentuss Expectorant, Co-Tuss V Expectorant, Endacof XP, Vicoclear, Propatuss Expectorant, Pneumotussin HC, Maxi-Tuss HCG, CodiCLEAR DH, Azdone, EndaCof-Tab, Ztuss ZT, Execlear, Tusso-HC, H-C Tussive-NR, Cytuss-HC NR, Anaplex HD, Bromplex HD, Relacon-HC, Drocon-CS, M-END, VazoTuss HC, Canges-HC, Maxi-Tuss HCX, Z-Cof HC, Tusana-D, Relacon-HC NR, Phendal-HD, Neo HC, Poly-Tussin HD, DroTuss-CP, Liquicough HC, Notuss-Forte, JayCof-HC, Cordron-HC, Hydrocof-HC, Hydron PCS, Cordron-HC NR, Atuss HD, FluTuss HC, Atuss HS, Hydrotuss HC, P-V-Tussin Syrup, Hexatussin, Welltuss HC, Pediatex HC, Tussin-V, Q-V Tussin, KG-Tussin, A-G Tussin, Donatussin MAX
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
CAS Registry Number
LactMed Record Number
Last Revision Date
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.