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Buprenorphine-Naloxone Maintenance and Lactation.
Lauren M Jansson1, Krystle McConnell1, Martha Velez1
1Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Summary
Buprenorphine-naloxone is safe for breastfeeding individuals with opioid use disorder. Studies show low buprenorphine levels in milk, and undetectable or very low naloxone levels, supporting its use in lactation.
Area of Science:
- Pharmacology
- Maternal-Fetal Medicine
- Toxicology
Background:
- Buprenorphine monotherapy is accepted for breastfeeding individuals with opioid use disorder due to low milk concentrations.
- Buprenorphine-naloxone use is increasing in pregnant and lactating individuals, but data on naloxone in human milk is lacking.
Purpose of the Study:
- To quantify buprenorphine, naloxone, and their metabolites in human milk, maternal plasma, and infant plasma.
- To assess the safety of buprenorphine-naloxone during lactation.
Main Methods:
- Four lactating individuals on buprenorphine-naloxone provided milk and plasma samples postpartum.
- Samples were collected on days 2, 3, 4, 14, and 30.
- Infant plasma was collected on day 14.
Main Results:
- Low concentrations of buprenorphine, norbuprenorphine, and their glucuronide metabolites were found in maternal plasma and milk.
- Naloxone was undetectable or below quantification limits in most maternal and infant plasma and milk samples.
- One milk sample showed detectable naloxone on day 30.
Conclusions:
- Findings support the use of buprenorphine-naloxone for breastfeeding individuals with opioid use disorder.
- The study provides crucial data on the safety of buprenorphine-naloxone during lactation.
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