Suboxone in pregnancy/ delivery after effects

[Bellasmom]

Hi I'm new to this site and also VERY grateful to have found it since I've noticed several MSN/MDs here.
I have been on 12mg suboxone for several years and became pregnant (totally unplanned and was on bC that failed). This med has been the only way I've been able to not completely destroy my own medical career, therefore, it has been a lot harder to wean off than I thought it would be. So now at 36 wks I'm still on 8mg sub daily. Because of the fear of my co-workers finding out about all of this (I work in a small facility where my OB also works) I have not disclosed this to him. I was also on Xanax but have weaned myself off this completely in the 1st trimester.
My questions are:
Are there any studies out yet on the long term effects of taking the med during pregnancy?
What can I expect at birth? About How long after birth would w/d sx start and what will they look like?
Will breast feeding while I'm taking this med help wean her from the suboxone?
Does suboxone pass into the colostrum?
Does suboxone interfere with milk production/ beginning lactation?
What is the likelihood of CPS being called?

I'm already considered high risk bc I'm 35, however all the blood/urine/ ultrasound scans have all been normal
I cannot begin to describe the anxiety and guilt I have over this. I am SO alone and afraid of all the unknown. ANY advice would be extremely appreciated.

[admin]

Bellasmom:

Breastfeeding:
As you know, Suboxone contains Buprenorphine + Naloxone. In one patient who received 4 mg/day to facilitate withdrawal from other opiates, the amount of buprenorphine transferred via milk was only 3.28 ?g/day, an amount that was clinically insignificant. No symptoms were noted in this breastfed infant. In another study of continuous epidural bupivacaine and buprenorphine in post cesarean women for 3 days, it was suggested that buprenorphine may suppress the production of milk (and infant weight gain) although this was not absolutely clear. In another study of one patient on buprenorphine maintenance for 7 months, and who received 8 mg daily sublingually over 4 days, milk levels of buprenorphine and norbuprenorphine ranged from 1 to 14.7 ng/mL and 0.6 to 6.3 ng/mL, respectively. Plasma concentrations of both analytes ranged from 0.2 to 20.1 ng/mL (buprenorphine) and 1.2 to 4.4 ng/mL (norbuprenorphine) over 4 days of study. Using peak levels only, the concentration of buprenorphine and norbuprenorphine were 1.47 and 0.63 ?g/100 mL of breastmilk, respectively. Assuming an intake of 150 mL/kg/day, the authors estimated the daily dose would be less than 10 ?g for a 4 kg infant, a dose that is probably far subclinical.

Based on several more studies it may be concluded that although experience with the use of buprenorphine in breastfeeding women is limited, there is no evidence that the use of this drug will have major adverse effects in the breastfed infants. The relative infant dose of buprenorphine is 0.09-1.9%.

In summary, it is unlikely that the breastmilk levels of the combination of buprenorphine + naloxone would be significant. Therefore the use of buprenorphine + naloxone is probably compatible with breastfeeding.

Pregnancy:
Studies in animals revealed no teratogenicity when used orally and intramuscularly in doses of up to 150 times the human oral doses and up to 35 times the human intramuscular doses. But in reality, we don't have much data on this product in breastfeeding mother, but I think it is unlikely to cause teratogenicity. However, the infant will be dependent, and go through withdrawal following delivery.

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So, with you upcoming delivery, you should probably realize that you will be less sensitive to any opiates that your OB might use. I'd suggest you have a frank discussion with your OB so that he/she knows about this and will understand why the pain relievers don't work in your case.

As for your infant, you probably need to discuss this with your pediatrician. The infant is certainly going to go through withdrawal and will need supplementation with an opiate to reduce the pain and misery associated with this. Perhaps your pediatrician can prescribe something that you can administer at home to help with withdrawal. But I imagine, they will want to admit your infant to the NICU for treatment of withdrawal.

Good luck.

Tom Hale Ph.D.

[Bellasmom]

I'm planning to not have any narcotics during delivery. My understanding is an epidural can be given without the added narcotics. Is this correct?

Thank you tremendously for your input.

[Sandra]

Bellasmom,

Look at the American Pregnancy Association website http://americanpregnancy.org/labor-and-birth/epidural/, and read about Epidural Anesthesia I think this will help explain everything. If you have any other questions please call the InfantRisk Center at 806-352-2519. Thanks

Sandra Lovato R.N.
InfantRisk Center

[admin]

Bellasmom:

Yes, epidural can be administered with an opioid, but its unlikely to work very well. It won't hurt, it just may not work as well.

Tom Hale

[Bellasmom]

Baby was born 8/24. The epidural worked fine. She was born with no s/s of withdrawal and was not admitted into the NICU. The infant was d/c with me from the hospital 48hrs post delivery.