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Hydrocodone use while Breastfeeding

Medically reviewed by Last updated on Dec 2, 2023.

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

Hydrocodone Levels and Effects while Breastfeeding

Summary of Use during Lactation

Hydrocodone is an opioid narcotic. Benzhydrocodone is a hydrocodone prodrug that is rapidly converted into hydrocodone in the gastrointestinal tract. Maternal use of oral opioids during breastfeeding can cause infant drowsiness, which may progress to rare but severe central nervous system depression. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. If hydrocodone is required by the mother of a newborn, it is not a reason to discontinue breastfeeding; however, 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 2 to 3 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


Anderson PO, Sauberan JB, Lane JR, Rossi SS. Hydrocodone excretion into breastmilk: The first two reported cases. Breastfeed Med 2007;2:10-4. [PubMed: 17661614]
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. [PubMed: 21343764]
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. [PubMed: 9429366]
Meyer D, Tobias JD. Adverse effects following the inadvertent administration of opioids to infants and children. Clin Pediatr (Phila) 2005;44:499-503. [PubMed: 16015396]
Tolis G, Dent R, Guyda H. Opiates, prolactin, and the dopamine receptor. J Clin Endocrinol Metab 1978;47:200-3. [PubMed: 263291]

Substance Identification

Substance Name

Hydrocodone; Benzhydrocodone

CAS Registry Number

125-29-1; 1259440-61-3

Drug Class

Breast Feeding


Milk, Human

Analgesics, Opioid


Antitussive Agents

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Further information

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