Codeine / guaifenesin Pregnancy and Breastfeeding Warnings
Codeine / guaifenesin is also known as: Allfen CD, Allfen CDX, Bitex Liquid, Cheracol with Codeine, Cheratussin AC, Codar GF, Dex-Tuss, Gani-Tuss NR, Glydeine, Guaiatussin AC, Guaitussin AC, Guiatuss AC, Guiatussin with Codeine, Halotussin AC, Iophen, Iophen-C NR, M-Clear, M-Clear WC, Mar-cof CG, Mytussin AC, Robafen AC, Robichem AC, Robitussin-AC, Romilar AC, Virtussin A/C
Codeine / guaifenesin Pregnancy Warnings
In rats, codeine has been shown to be embryolethal and fetotoxic at maternally toxic doses. In rats and rabbits administered doses ranging from 5 to 120 mg/kg during the period of organogenesis, teratogenicity was not observed. Prolonged use of opioids during pregnancy has resulted in babies born physically dependent. Opioids administered to mothers shortly before delivery may result in some degree of newborn respiratory depression, especially with higher doses. Limited data is available on guaifenesin use in pregnancy; although it does not appear to present a risk. There are no adequate and well-controlled studies in pregnant women.
Benefit should outweigh risk Comments: -Prolonged use of opioids during pregnancy can result in physical dependence in the neonate; women should be advised of the risk of neonatal abstinence syndrome and ensure that appropriate treatment will be available. -Some liquid preparations contain alcohol.
Codeine / guaifenesin Breastfeeding Warnings
Codeine is present in breast milk and for women with normal codeine metabolism (normal CYP450 2D6 activity). The amount of codeine secreted is low and dose-dependent; however, in women who are ultra-rapid metabolizers of codeine (those with a specific CYP450 2D6 genotype) higher-than-expected serum levels of morphine (codeine's active metabolite) may be present in breast milk which may lead to dangerously high serum morphine levels in breastfed infants. In most cases, a person's specific CYP450 2D6 genotype is unknown. Several small series and 1 small retrospective study suggest that codeine may be causative in episodes of apnea, bradycardia, and cyanosis in the first week of life. A death of a breastfeed infant due to respiratory depression has been reported; the mother was found to be a CYP450 2D6 ultrarapid metabolizer.
Benefit should outweigh risk Excreted into human milk: Yes (codeine); Unknown (guaifenesin) Excreted into animal milk: Yes (codeine); Data not available (guaifenesin) Comments: -The American Academy of Pediatrics recommends that other agents are preferred over codeine during breastfeeding. -If used, mother-infant pairs should be closely monitored; treating pediatricians should be advised about the use of codeine during breast-feeding.
References for pregnancy information
- Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
- Koren G, Pastuszak A, Ito S "Drugs in pregnancy." N Engl J Med 338 (1998): 1128-37
- "Product Information. Codeine Sulfate (codeine)." Roxane Laboratories Inc, Columbus, OH.
References for breastfeeding information
- Seymour S "Joint Pulmonary-Allergy Drugs and Drug Safety and Risk Management Advisory Committee Meeting, FDA Introductory Remarks. Available from: URL: http://www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials/drugs/pulmonary-allergydrugsadvisorycom" ([2015, Dec 10]):
- United States National Library of Medicine "Toxnet. Toxicology Data Network. Available from: URL: http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT." ([cited 2013 -]):
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