By Lorrie Harris-Sagaribay, MPH, MotherToBaby North Carolina
Safe and effective pain management requires careful consideration for anyone, but breastfeeding moms have an additional factor to consider: the possible effects of pain medications on their breastfeeding babies.
The US Food and Drug Administration (FDA) recommends avoiding the use of codeine and tramadol while breastfeeding. Codeine and tramadol (Ultram®) are opioid pain medications, or narcotics. Codeine is also found in some cough and cold medications.
While any opioid medication should be used with caution during breastfeeding, the special concern about codeine and tramadol is that some people process, or metabolize, these medications more quickly and extensively than others do. If you happen to be one of these “ultra-rapid metabolizers,” then more of the active ingredients in codeine or tramadol can get into your breast milk. If an infant gets too much of these active ingredients from the breast milk, it can cause extreme sleepiness, serious breathing problems or even death. Unfortunately, most people don’t know if they are ultra-rapid metabolizers or not, so the FDA advises against using codeine or tramadol at all during breastfeeding.
So, what’s a mom-in-pain to do?
Talk to your healthcare provider about managing your pain with medications that are not opioids, such as acetaminophen and ibuprofen. If you still need an opioid medication to manage your pain, talk to your healthcare provider about the safest way to use these narcotics while breastfeeding, keeping in mind that some infants can be sensitive to even small amounts of opioids in the breast milk. In general, it’s best to use opioids only as needed for no more than a few days. During this time, watch your infant carefully for any unusual drowsiness or breathing problems. If you notice these symptoms, stop using the medication and contact your infant’s doctor right away.
Lorrie Harris-Sagaribay, MPH, coordinates MotherToBaby North Carolina, housed at the Mission Fullerton Genetics Center. MotherToBaby is a free service of the Organization of Teratology Information Specialists (OTIS).
- U.S. Food & Drug Administration: Use of Codeine and Tramadol Products in Breastfeeding Women – Questions and Answers: https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm118113.htm