Hydrocodone and Breastfeeding

[mommytobe2012]

Hello,

I will be expecting my first child in early June and throughout my pregnancy I have been taking Norco 10/325 mg tablets 4 times a day for chronic pain, which is prescribed by my pain management doctor. My question is does anyone have any information on the medical research and facts on the usuage of hydrocodone while breastfeeding? I discussed this with my pain management doctor and I told him that my desire was that I wanted to breastfeed and that I was considering getting off the Norco before my baby is born. Unfortunately, my doctor felt that was not the best decision because I will still be dealing with a large amount of daily pain and that it may become more extreme after the pregnancy. He did not know the medical literature of hydrocodone usuage and breastfeeding and told me to discuss this issue with my OBGYN, which I plan to do at my next monthly appointment. Therefore, any information would be greatly appreciated because I am in a serious dilemma as to whether I even have the option to take Norco at a lower dosage while breastfeeding or if I need to taper down and get off of the Norco before my baby comes. Please respond if you have any information and thanks so much.

[admin]

Mommytobe:

We have lots of data and experience on the use of hydrocodone in breastfeeding mothers. Used postpartum, it is normally only used for several days. In chronic states such as yours, you should probably expect the infant to become somewhat dependent on the even low dose present in milk. While not an overt problem, you'd need to observe for constipation and somnolence. I doubt either of these would occur in your situation.

Because you have been using this during pregnancy, I would expect your infant to go through a modest withdrawal postpartum even if you continue to breastfeed. You MUST inform your pediatrician that you were taking this during pregnancy.

Normally, the amount of hydrocodone that gets to an infant is about 2.4% - 3.7% of the maternal dose. This is normally OK for a breastfeeding infant.

So my advice would be for you to continue your medications as at present, and decide later what to do. One thing you should not do, is precipitously withdraw or stop using this medication postpartum. The infant could have a severe withdrawal.
Always taper off an opiate drug.

Tom Hale Ph.d.

[miricalemomof2]

question...i have bulged discs (4) & arthritis in my back. i ebf my 2 mo old...shes a little over 14lbs & gaining weight perfectly. whats the max recomended dose of hydrocodone daily?

[admin-james]

Hi, thanks for your post.

There is not a maximum recommended dose of hydrocodone. Both infants and adults gradually develop a tolerance to the negative effects of opiates over time. Although your baby is only getting a small amount of medication through the milk, she should still be transitioned slowly up to breastmilk that you produce on your full dose of hydrocodone. You can do this by alternating breast milk and formula for a couple of weeks. Watch your daughter for sedation (she does not wake up for feedings) and constipation. You should also transition down slowly if you wean her off breastmilk or yourself off hydrocodone. This will help to prevent withdrawal symptoms.

Hydrocodone pills often have acetaminophen (Tylenol) in them, as with Vicodin and Norco. The maximum daily dose of acetaminophen from any source is 4 grams (4000 mg).

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

-James Abbey, MD