Alcohol and cocaine

[Amandalauraco]

On saturday my friend did one small line of cocaine and had a couple of drinks. She has been breastfeeding a 4 week old and doesn’t know when it will be safe to resume. When will the drug be completely out of her system considering she mixed with alcohol?

Amanda

[admin]

Amanda: Cocaine and alcohol have a very short half life. I'd say wait 12-24 hours after taking cocaine. Alcohol, wait 2 hours for each 4 oz drink.

Tom Hale Ph.D.

[Amandalauraco]

Is this still the Case considering alcohol and cocaine was mixed? Will there not be cocaethylene present in the breast milk as the half-life is considerably longer? Or does it not pass in to breast milk?

Amanda

[admin]

Amanda:
While cocaethylene is indeed produced from the admixture of ethanol and cocaine, the half-life of both are relatively short. The half life of cocaine is about 91 minutes and cocaethylene T1/2 is about 141 minutes.(1) Almost all of both of these drugs is gone in 300 minutes or 5 hours in the paper below. In general, we suggest that after 5 half lives 98% of any drug is gone from the human.

So I still suggest that a 24 hour waiting period is enough time to allow to reduce the risk of cocaine and its metabolite.

Tom Hale Ph.D.


1. Hart CL, Jatlow P, Sevarino KA, McCance-Katz EF. Comparison of intravenous cocaethylene and cocaine in humans. Psychopharmacology (Berl). 2000 Apr;149(2):153-62. PubMed PMID: 10805610.

[edsonsouza71@yahoo.com.br]

Dear Thomas Hale,

In the chapter of COCAINA, from your book you say that “Breastfeeding mothers should avoid cocaine use. In those individuals who have ingested cocaine, a minimum pump and discard period of 24 hours is recommended before breastfeeding could be considered. [1-8]”

I carefully read each of the references you used and found that only 2 cases of acute intoxication were reported. In the first, the mother was acutely intoxicated when breastfeeding. In the second, the newborn was exposed directly to cocaine applied on the nipple. All other references have described toxicological variables, without assessing the clinical consequences of exposure to the newborn.

Your review allows me to make the following conclusions:
1. Exposure to cocaine through milk presents risks of acute intoxication for the infant;
2. The risk of acute intoxication is related to the concentration of cocaine in milk, the volume of milk ingested and the maturity of drug elimination mechanisms
3. Considering pharmacokinetic data, it seems reasonable to wait for a time to eliminate cocaine; and discard the milk produced during the period of high maternal serum concentration.

However, this 24 hour time is arbitrary and I think it is excessive in at least two situations:

1. In the immediate postpartum. In the first 24 hours the volume of milk ingested by the newborn is very small. In the first hour of life, the volume of ingested colostrum is of the order of 1-2 ml. The first feed is intended to strengthen bonding and learning. Then the newborn enters a period of sleep and relaxation and suckles after 6-12 hours. If the mother is calm, with no signs of acute intoxication, even if the last use occurred < 24 hours (eg 6 hours), why should we deprive this newborn from skin-to-skin contact and breastfeeding in the first hour of life?

2. Women who have lost custody of their child. These women do not exclusively breastfeed their child and, because of this, milk production is probably already reduced. These women usually visit their children once a day and may want to breastfeed. Breastfeeding in these cases has a secondary nutritional function. Its major importance is to preserve the bond and promote parenting.

Therefore, we think that:

1. In the first 24 hours of life there should be no restriction to breastfeeding (in our institution we have adopted this policy and have no reports of acute newborn intoxication)
2. 2. In women who infrequently breastfeed their children after discharge from hospital, breast-feeding would be permitted if the woman shows no signs of acute intoxication; > 12 hours from the last maternal exposure to cocaine; if the milk produced in this period was discarded. If this mother-infant contact can be observed (breastfeeding under supervision).

What do you think about that?

MD. Edson Borges de Souza (gynecologist and obstetrician)
Coordinator of Medical Residency in OBGyn
Hospital Sofia Feldman
BRAZIL