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Hydrocodone excretion into breast milk: the first two reported cases
Philip O Anderson1, Jason B Sauberan, James R Lane
1Department of Pharmacy, University of California San Diego Medical Center, San Diego, California 92103-8925, USA. phanderson@ucsd.edu <phanderson@ucsd.edu>
Summary
Hydrocodone excretion into breast milk is minimal, with infants receiving a small percentage of the maternal dose. Moderate hydrocodone use appears safe for breastfeeding infants, but further research is needed for maximum dosage guidelines.
Area of Science:
- Pharmacology
- Neonatal Medicine
- Lactation Studies
Background:
- Hydrocodone is a commonly prescribed narcotic analgesic, frequently used by nursing mothers.
- Existing literature lacks data on the quantitative excretion of hydrocodone into human breast milk.
- Concerns exist regarding potential adverse effects on breastfed infants.
Observation:
- Two breastfeeding mothers taking an acetaminophen and hydrocodone combination product provided donated breast milk samples.
- Breast milk samples were analyzed to quantify the amount of hydrocodone present.
- Infant exposure was calculated based on milk intake and maternal dosage.
Findings:
- Infants received an estimated 3.1% and 3.7% of the maternal weight-adjusted hydrocodone dosage.
- Absolute hydrocodone dosages received by infants varied (8.58 microg/kg/day and 3.07 microg/kg/day) due to maternal dose differences.
- These findings suggest a low level of hydrocodone transfer via breast milk.
Implications:
- Moderate hydrocodone use may be acceptable during breastfeeding, but optimal safe dosages require further investigation.
- Neonates and preterm infants might be more vulnerable to hydrocodone and its metabolites in breast milk.
- Additional research is crucial to establish comprehensive safety guidelines for hydrocodone use in lactating women.
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