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  • Breastfeeding & Tramadol

    How long after taking 100mg of Tramadol do you need to wait to breastfeed?
    should you pump and dump in the mean time ?

  • #2
    22013,

    Tramadol is rated an L3-limited data-probably compatible. The amount that transfers into breast milk is 2.86% of your dose. Tramadol peaks at 2 hours and the half-life is 7 hours. Take your medicine right after you nurse or pump so that you have a break before nursing again. We think short term use is probably ok as long as your infant is not symptomatic. Monitor for sedation, slowed breathing rate/apnea, pallor, constipation, not waking to feed/poor feeding.

    Sandra Lovato R.N.
    InfantRisk Center

    Comment


    • #3
      What does the half life mean is that when it’s completely out of your milk supply ?

      Comment


      • #4
        22013,

        The half-life is the amount of time it takes for medications to be reduced to 50% of the beginning plasma levels in the body. The medications continue to drop by half of the remaining amount at each half-life. With most medications it takes 5-6 half-lives to be completely out of the system.

        For example:

        If a medication has a half-life of 4 hours it is 50% out at 4 hours, then at 8 hours it is 75% out (half of 50 is 25 added to 50=75%), then at 12 hours it is 87.5% (half of 25 is 12.5 added to 75=87.5%) out etc.

        Sandra Lovato R.N.
        InfantRisk Center

        Comment


        • #5
          What would be the safest way If this is a medication that will be used long term ?

          as now I pump in the mornings which is about 2 half lives after taking the last medication and when nursing in the evenings it’s been one full half life since taking the medication

          ive not noticed any side effects, sedation, breathing ect
          or should we switch to formula
          I know breastfeeding is always recommended but I want to be sure we are taking the safest route possible

          Comment


          • #6
            22013,

            We recommend taking the medication right after nursing and avoiding the peak time of the first 2 hours. The way you are taking this medication and nursing as described above sounds good as long as it works well for you. We think you can continue to nurse as long as your infant is not symptomatic, watch for sedation, slowed breathing rate/apnea, pallor, constipation, not waking to feed/poor feeding and poor wt gain.


            Sandra Lovato R.N.
            InfantRisk Center

            Comment


            • #7
              Sandra re open this.. my infant is still doing well nursing as we have discussed above.
              After reading an article of a child who died from breastfeeding after Tramadol I’m starting to consider my options
              i take roughly 300 mg per day, even with avoiding the peak times after taking the medication from nursing, should I do a slow taper until I am off the medication for a few days and then start formula instead of stoping breastfeeding right away?
              i just want to do what is best for my baby with a clear mind

              Comment


              • #8
                22013,

                I believe you are referring to the article about an 8 month old that died from tramadol intoxication. A quote from this article states " When assessing this infant with tramadol intoxication, we should consider that the source of tramadol may be from the infant’s ingestion of the maternal medication in addition to the breast milk as the mother could continue
                taking tramadol and breastfed her child after discharging from the hospital at the first time in spite of warning her." ([url]https://webcache.googleusercontent.com/search?q=cache:PYZZZUtDaC8J:https://www.longdom.org/open-access/tramadol-intoxication-in-an-8monthsold-infant-through-breastfeeding-a-case-report-2161-0495-1000335.pdf+&cd=15&hl=en&ct=clnk&g[/url] l=us,Rania Hussien Mohamed Hussien, Department of Forensic Medicine and Clinical Toxicology, Ain Shams University, Tel: 01006192080). This article was published 1/23/2017.

                An article from the FDA current as of 8/1/2019 states that although tramadol is not recommended in breastfeeding women, no adverse reactions have been reported through breastfeeding, only in pediatric patients who received the tramadol directly for pain control usually after a surgery. " A review of the available medical literature for data regarding tramadol use during breastfeeding did not reveal any cases of adverse events."
                ([url]https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/use-codeine-and-tramadol-products-breastfeeding-women-questions-and-answers[/url]).

                I am not sure why the FDA does not make mention of this case report from Cairo Egypt.
                We are not certain that the 8 month old in the above article did not ingest the tramadol directly, or if they are referring to exposure through the breast milk only. We also do not know how much tramadol this mom was using. The parents had a history of tramadol abuse.

                The way you stated you are using tramadol and waiting to nurse is probably ok as long as your infant is not symptomatic. If you want to stop nursing then yes you need to wean your infant off slowly so that they do not go through withdrawals.

                Sandra Lovato R.N.
                InfantRisk Center

                Comment


                • #9
                  I’ve never noticed any symptoms of anything concerning.
                  another article mentioned that it builds up over time in the system and could lead to problems?

                  if I were to stop nursing or to stop taking the Tramadol and suffer through Im done nursing what would be a good taper schedule ?
                  i don’t want to put my baby through a withdraw

                  Comment


                  • #10
                    22013,

                    Please speak with your pediatrician about a tapering schedule.

                    Sandra

                    Comment


                    • #11
                      I will find out what a schedule would be
                      in the mean time you think avoiding the 2 hours after taking the medication and feeding pumped milk if needed in that time frame should be ok?
                      do you know anything about it potentially. Building up in the system and overtime causing a problem or is there only that one case of something happening

                      Comment


                      • #12
                        22013,

                        The only thing I can find is that it can prolong the elimination half-life in someone who has impaired renal or liver functions, and those over the age of 75.

                        "Tramadol is eliminated primarily through metabolism by the liver and the metabolites are eliminated primarily by the kidneys. The mean terminal plasma elimination half-lives of racemic tramadol and racemic M1 are 6.3 ± 1.4 and 7.4 ± 1.4 hours, respectively. The plasma elimination half-life of racemic tramadol increased from approximately six hours to seven hours upon multiple dosing." (Dailymed). "Metabolism of tramadol and M1 is reduced in patients with advanced cirrhosis of the liver, resulting in both a larger area under the concentration time curve for tramadol and longer tramadol and M1 elimination half-lives (13 hrs. for tramadol and 19 hrs. for M1)." (Dailymed).

                        Sandra Lovato R.N.

                        https://www.infantrisk.com/forum/core/image/gif;base64,R0lGODlhAQABAPABAP///wAAACH5BAEKAAAALAAAAAABAAEAAAICRAEAOw==https://www.infantrisk.com/forum/core/image/gif;base64,R0lGODlhAQABAPABAP///wAAACH5BAEKAAAALAAAAAABAAEAAAICRAEAOw==

                        Comment


                        • #13
                          So avoiding the 2 hours after dosing (I try avoiding 3-4 hours after dosing)
                          and feeding pumped breast milk in that time frame that was pumped at least 4 hours after dosing but mostly one full half life or more has passed before any milk is pumped.
                          that should be a safe approach without having to swap to formula?

                          Comment

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