Tramadol and Methocarbamol(Robaxin)

[tatroj1]

I have been taking Tramadol 50-100 mg 4x daily for the past 3 years due to arthritis, sacroilitis, chronic muscle pain/inflammation, and nerve pain due to nerve damage caused by chronic issues with an eating disorder. It's managed by my Rheumatologist, and I continued on Tramadol at 50mg 4x daily during pregnancy. It never caused any issues during pregnancy or after birth. All of my OB's didn't have an issue with Tramadol and knew that I intended on breastfeeding and never mentioned it as a concern. Her pediatrician uses Dr. Hale's book and didn't see an issue with Tramadol and breastfeeding. Our daughter is now almost 5 weeks old and I have been almost exclusively breastfeeding/pumping, with some occasional bottles of formula. I'm needing to start taking 100mg 4x a day again, and start back on Robaxin 500mg 1-3x daily. The Robaxin is listed as compatible with breastfeeding by the AAP, but I wanted to check. I'm concerned about both the increase of Tramadol dosage and the Robaxin. I'm also concerned about the medications building up in her system and causing serious issues, especially the Tramadol, since its something I take daily. I have 2 other children and never needed to take any medications during pregnancy or breastfeeding with them, so this is all new to me and makes me nervous. Is it safe for me to continue breastfeeding with an increase in Tramadol dosage, as well as taking Robaxin at times?

[cpride]

Dear tatroj1,

Minimal amounts of tramadol enter breastmilk. The usual adult dose is 50 to 100 mg every 4 to 6 hours as needed for pain so your dose is within the usual range. The study revealed no significant neurobehavioral adverse effects between controls and exposed breastfeeding infants thus tramadol appears to be compatible with breastfeeding. You should observe your infant for sedation. The time the medication is highest in your milk is the first two hours after you take your dose, so try to avoid breastfeeding during that time. Methocarbamol (Robaxin) is a centrally acting sedative and skeletal muscle relaxant. Only minimal amounts have been found in animal milk but no human milk studies have been found. No pediatric concerns have been noted, but studies are limited. Observe for sedation in your infant. The time the methocarbamol is highest in your breastmilk is the first two hours after your dose so try to avoid breastfeeding during that time. The usual adult dose is 4 to 4.5 gm every 4 to 6 hours so you are on a low dose. If you have further questions, please call the InfantRisk Center at 806-352-2519. We are open 8 to 5, CDT, Monday through Friday.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

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