Is maternal opioid use hazardous to breast-fed infants?

Robert G. Hendrickson, Nathanael J. McKeown

Research output: Contribution to journalReview article

32 Scopus citations

Abstract

Over the last few decades, the rate of breastfeeding has increased steadily in the developed countries of the world. During this time, opioid use in the general population has steadily increased as well. Despite this, clinicians remain unclear whether opioid use is safe during breastfeeding. While the vast majority of medications used during breastfeeding occur without incident, case reports and studies have reported possible opioid toxicity in breast-fed infants. Multiple enzymes are involved in the metabolism of opioids. CYP2D6 catabolizes O-demethylation of codeine, tramadol, oxycodone, and hydrocodone to more potent metabolites. CYP3A4 inactivates methadone, meperidine, and buprenorphine. Glucoronide conjugation by the UGT enzyme family inactivates morphine and hydromorphone. Genetic polymorphisms and interfering medications affect the maternal metabolism, which in turn determines the exposure and risk to the breast-fed neonate. We review the production of breast milk, the transfer of xenobiotics from blood to milk, the characteristics that alter xenobiotic breast-milk concentrations, and we review the evidence of specific common opioids and infant toxicity. The short-term maternal use of prescription opioids is usually safe and infrequently presents a hazard to the newborn.

Original languageEnglish (US)
Pages (from-to)1-14
Number of pages14
JournalClinical Toxicology
Volume50
Issue number1
DOIs
StatePublished - Jan 1 2012

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Keywords

  • Analgesics
  • Breast milk
  • Breastfeeding
  • Human milk
  • Opioids

ASJC Scopus subject areas

  • Toxicology

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