Norcos and percocet

[Aliris19]

Can you please indicate whether you agree with this mom's HCP who suggested pumping/dumping after the following:
"I am on two 10 mg norcos every four to six hours during the day and two percocet 5/325 at night every four hours."

The rx is for severe nerve pain for which she will undergo surgery in a week. In the meantime, her supply has dwindled terribly and I cannot tell whether the suggestion to pump/dump is warranted under the circumstances. Her HCP indicated a concern with dependence in the infant (10 weeks), though from what I see in your book it doesn't seem this is of great concern. However, the dose and chronic use may affect this issue.

Thanks a lot for the help.

[admin]

Aliris19:

These doses are concerning IF the infant has not been exposed to them previously. If this dosing is new, I'd suggest she not breastfeed. Remember, using high doses in a naive breastfed infant is potentially hazardous.

If the infant were exposed over time, and has become tolerant of this dose, then it is less risky.

Perhaps she could pump, and mix half and half with formula to reduce the dose. But even then, I'd worry the infant may become tolerant, then dependent, then potentially withdraw if her milk drops off further.

Tom Hale Ph.D.

[Aliris19]

Thanks, Dr Hale. It seemed a hopeful idea to dilute the milk. The mom says that while this high dose is prescribed she rarely gets this high in intake. She seemed pleased to know the dose limit recommendation suggested by the person staffing your hotline. (total of 60mg/d hydrocodone).

I also suggested that while breastmilk may be ideal, we are most fortunate to live in a time and place where formula is available to sustain our babies in these rare, difficult and potentially dangerous situations. It seems to me the job of the lactation consultant here might be to support her grief in being -- hopefully temporarily -- unable to directly breastfeed safely.

BTW, I believe the infant is functionally naive to this dose. The infant is 10 weeks and mom has been pumping/dumping, so I do not believe the baby has been slowly habituated.

Thanks again for this forum. I appreciate the information and expert opinions very much.