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  • Cocaine

    If you are breastfeeding and used cocaine stupidly as a one off how long should you wait until resuming breastfeeding? Or is it recommend to stop all together and swap the baby to formula?

  • #2
    Hi, thanks for your post.

    We recommend that you wait 24 hours before you start breastfeeding again. It is not necessary to discard your milk. Your milk will continue to contain the inactive metabolite of cocaine, benzoecgonine, for quite a while. This metabolite is not dangerous, but it can trigger a positive urine test for cocaine in your infant. This test may be positive for up to 2 weeks.

    Please call us at the InfantRisk Center if this has not completely answered your question.*(806)352-2519

    -James Abbey, MD


    • #3

      I am also curious about this subject as I just discovered my sister used a small amount of cocaine Friday night after being told it would clear from her breast milk in a couple of hours. She had drank and apparently wasn’t thinking, then later (2-3 hrs or so) went home to sleep and her 14 month old nursed a few times in the next 24 hours. It has now been 4 days since this, but I am just now finding out about this and she is paranoid her baby could be harmed since she did not wait at least 24 hrs before nursing. He never showed any side effects and has acted normal ever since. Does she need to be worried at this point?


      • #4
        Cocaine is rapidly cleared from the body certainly by 24 hours. In this case if the infant has no symptoms then it is surely ok. But just be sure to not do this again.

        Tom Hale


        • #5
          I’m trying to help a close friend of mine find some peace on this subject. She is not a regular (or even occasional) drug user, but a couple of months ago she ingested two small snorts of cocaine after having a couple of drinks at a party. A physician friend told her that, based on the small amount consumed, she probably didn’t need to pump and dump. She ended up pumping/dumping a couple of hours later and then a couple of hours after that fed her 9 month old infant. Thankfully, the infant demonstrated no adverse symptoms at all, but after extensively researching the subject (including Dr. Hale’s literature), she learned how very dangerous cocaine is to an infant. Although the baby seems totally fine, she is panicked that, had she not pumped once before feeding, she could have seriously harmed her. My questions is this: despite cocaine’s tendency to become ion-trapped in milk, is it possible that any amount might have already passed out of her breast milk in the couple of hours after she ingested and before she pumped? I am positive given how upset she continues to be that this will never happen again, but I’m trying to give her some information that will help her move on.


          • #6

            Here is our data "Breastfeeding mothers should avoid cocaine use as numerous case reports demonstrate cocaine enters human milk. In those individuals who have ingested cocaine, a minimum pump and discard period of 24 hours is recommended before breastfeeding could be considered." Medications and Mothers' Milk database. Dr. Thomas W. Hale, Kaytlin Krutsch. This guideline is if mom does not continue to use any illicit drug, we usually follow the Academy of Breastfeeding Medicine guideline # 21. I hope this helps.

            Sandra Lovato R.N.
            InfantRisk Center


            • #7
              Thank you, I appreciate the info. I think part of what I’m trying to understand from her situation is whether cocaine eventually passes out of milk or if it truly is trapped and stays there until it’s pumped out. Put another way, if a mother didn’t pump and dump but waited the 24 hours before feeding, would her milk be safe?


              • #8
                Almost all substances move into milk and out of milk at about the same rate. I expect cocaine and its metabolites to do the same--when there is drug in the blood, it will pass into breastmilk. As the body metabolizes it out of the blood, it will pass back out of the milk into blood, where it too is metabolized. Very few things are "trapped" in the milk--no need to pump and dump as long as waiting periods are observed (unless mom needs to pump for comfort).

                Dr. Krutsch​
                Attached Files


                • #9
                  Thank you, Dr. Krutsch. I’m confused by this answer, though, as the Infant Risk website states this:
                  In some instances, drugs become ion trapped in milk, meaning that due to the lower pH of human milk, the physicochemical structure of the drug changes, and prevents its perfusion back into the maternal circulation.​

                  I’ve read in several places that cocaine is one of these substances. If that is true, do other mechanisms lead to the drug ultimately passing out of the milk, or would pumping be the only way to ensure that the drug leaves the milk compartment?