Is Cocaine safe while breastfeeding?
Here is what NIH LactMed, the U.S. National Library of Medicine's authority on medicines and breastfeeding, reports about Cocaine. This is a summary of that source — not our own verdict.
Effects on the breastfed infant
A woman who was breastfeeding her 1-week-old daughter reported using a "dab" of cocaine on her lower gum and nursing her infant with no effect on her infant's behavior or sleep pattern. One week later she used about 500 mg of cocaine intranasally over a 4-hour period and breastfed 5 times during this period. Three hours after first ingesting the cocaine, the mother noted that her infant became markedly irritable, had dilated pupils, and began vomiting and having diarrhea. The infant became increasingly irritable and was taken to the emergency room 4 hours later. On examination, the infant was found to be tremulous and irritable with frequent startling after minimal stimulation, and to have high-pitched crying, hyperactive reflexes, mood lability, and hypertension. The infant also had some signs of fetal alcohol syndrome. The infant remained irritable 12 hours after the last cocaine exposure and remained tremulous and easily startled 24 hours after the last exposure. Irritability and tremulousness slowly abated over the subsequent 24 hours. Mild hypertension persisted up to 72 hours after the last cocaine exposure via breastmilk.[ 7 ] The mother of an 11-day-old infant applied cocaine powder to her nipples for pain relief. She then breastfed her infant using a breast shield that allowed protrusion of her nipples. Three hours later, she found the infant gasping, choking and blue. On arrival at the emergency room, the infant was ashen and cyanotic. He had hypertension, tachycardia, shallow breathing, hypothermia and was in status epilepticus. Seizures resolved in a few hours after treatment and the infant was discharged at 16 days of age with no apparent sequelae.[ 16 ] Although the infant's cocaine exposure was not via the drug in breastmilk, it illustrates the extreme risk of exposure of young infants to cocaine. A one month and 3 day-old infant born at 36 weeks of gestation was brought to the emergency room with hypoactivity, sensory impairment and nose bleeding. Th
Effects on milk supply
Long-term cocaine use can result in chronic, low-level hyperprolactinemia.[ 19 - 21 ] The prolactin level in a mother with established lactation may not affect her ability to breastfeed. Mothers who use cocaine initiate breastfeeding of their infants less frequently than mothers who do not use cocaine.[ 22 , 23 ]
Levels in milk
Cocaine is metabolized to benzoylecgonine which serves as a marker for cocaine ingestion. Other cocaine metabolites include ecgonine methyl ester and norcocaine. When cocaine and alcohol are taken together, cocaethylene is produced; its metabolite is ethylbenzoylecgonine. Both of these compounds are markers for concurrent use of cocaine and alcohol. Maternal Levels. A woman reported using 500 mg of cocaine intranasally over a 4-hour period. Her milk contained about 10 to 15 mcg/L of cocaine 12 hours after ingestion that slowly decreased until 36 hours after the last use when it was unmeasurable. The benzoylecgonine concentration in her breastmilk was about 400 mcg/L at 12 hours after ingestion and dropped to undetectable levels by 36 hours post-ingestion.[ 7 ] Screening of breastmilk samples of 11 postpartum women who admitted to having used cocaine prepartum found primarily cocaine and benzoylecgonine in breastmilk of 6 of the women. Ecgonine methyl ester was usually not detected and only traces of norcocaine were detected unless cocaine concentrations were very high. One such subject had a concentration of 12.1 mg/L of cocaine, 4.1 mg/L of benzoylecgonine and 119 mg/L of ecgonine methyl ester in her breastmilk.[ 8 ] Ethylbenzoylecgonine has been found in the breastmilk of mothers who ingested cocaine and alcohol.[ 1 ] Breastmilk from a mother who admitted to cocaine use contained cocaine in a concentration of 5 mcg/L. The time of collection and amount of drug use was not stated.[ 9 ] Two women suspected of cocaine use prior to delivery had cocaine levels of 8 and 10.3 mcg/L in their colostrum. Benzoylecgonine (7.8 mcg/L) and the pyrolytic products anhydroecgonine methyl ester (9.5 mcg/L) and anhydroecgonine (9.8 mcg/L) were also detected in the mother with the higher cocaine level in colostrum. The pyrolytic products resulted from smoking crack cocaine.[ 10 ] A woman who admitted to 2 years of cocaine and cannabis use provided breastmilk sample 24 hours after deli
Source: NIH LactMed (National Library of Medicine).
Educational summary of an authoritative source — not medical advice. Never start, stop, or change a medicine while breastfeeding without confirming with your doctor.