Fentanyl

[A zebra among horses]

Before conceiving I was on 50mcg fentanyl patch every 72hours for fibro and Ehlers Danlos.
My doctor doesn't know if it would be safe to resume this route of pain management without having to stop breast feeding. My daughter is 8 months if that matters.

[admin-james]

Dr. Hale and I have discussed this question. We give fentanyl an L2 (out of 5) ("Probably Compatible") with regards to its lactation safety. Experience with the use of this drug in breastfeeding women is limited. However, there is no evidence that the use of this drug will have an adverse effect in the breastfed infant. Fentanyl is probably safe to use during breastfeeding since only low levels pass into milk. There have been no reports of adverse effects in the breastfed infant, however you might want to watch for sedation and/or constipation.

Also, we'd suggest you increase the dose slowly over a few weeks as some of it will pass to the infant. The infant may become somewhat dependent on these low levels and you should withdraw the drug, or stop breastfeeding, slowly over time so that the infant doesn't have a hard withdrawal.

If the infant has a history of apnea, caution is advised. Please call us at the InfantRisk Center if this has not completely answered your question. (806)352-2519

-James Abbey, MD

The following references may be useful to your physician if he or she needs more information:

Leuschen MP, Wolf LJ, Rayburn WF. Fentanyl excretion in breast milk. Clin Pharm 1990; 9(5):336-337.
Steer PL, Biddle CJ, Marley WS, Lantz RK, Sulik PL. Concentration of fentanyl in colostrum after an analgesic dose. Can J Anaesth 1992 March; 39(3):231-5.
Cohen RS. Fentanyl transdermal analgesia during pregnancy and lactation. J Hum Lact. Aug 2009;25(3):359-361.