Is Hydromorphone safe while breastfeeding?
Here is what NIH LactMed, the U.S. National Library of Medicine's authority on medicines and breastfeeding, reports about Hydromorphone. This is a summary of that source — not our own verdict.
Effects on the breastfed infant
A 6-day-old infant was being partially breastfed by a mother who was taking oral hydromorphone 4 mg every 4 hours for pain following a cesarean section. The infant was brought to the emergency department because of excessive drowsiness. The infant was having intermittent bradycardia and had an apneic event requiring bag-valve-mask intervention. The infant received 0.36 mg of naloxone and within 30 seconds developed spontaneous respirations, a heart rate of 165 beats/minute and increased alertness. Fifteen minutes later, he had another apneic episode that resolved rapidly with another dose of naloxone. Extensive laboratory testing found that all tests were negative, including a urine opiate screen. The authors note that most urine opiate screening tests are insensitive to semisynthetic opiates such as hydromorphone that are not metabolized to morphine.[ 3 ] The infant's apnea was probably caused by hydromorphone in breastmilk. An infant was born to a mother with opioid use disorder who was taking up to 2 grams of intravenous fentanyl daily. In the hospital she was transitioned to intravenous hydromorphone 120 mg three times daily, oral hydromorphone 32 mg every hour as needed, and methadone 70 mg daily by mouth. After 9 days of tapering the oral morphine dosage, the infant was given 72 mL of the mother s expressed milk. On day 10, the infant received two doses of 0.1 mg of oral morphine and then breastfed for 30 minutes 3 hours after a maternal dose of 110 mg of intravenous hydromorphone. The infant was alert and active, feeding and sleeping well, and the infant s morphine was discontinued. There were no clinically relevant episodes of apnea, bradycardia, desaturation, signs of respiratory depression, or excessive sedation. The infant continued to receive formula plus either breastfeeding or expressed milk with no clinically important adverse effects. The mother s hydromorphone dose was tapered over 47 days while oral methadone and oral slow-release morphine were inc
Effects on milk supply
Opioids can increase serum prolactin.[ 6 ] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed. A randomized study in women receiving a cesarean section compared postoperative patient-controlled analgesia with hydromorphone 0.2 mg/kg to sufentanil 2 mcg/kg. Both regimens included intravenous palonosetron 4 mcg/kg. The hydromorphone group had higher breastfeeding satisfaction at 72 hours postpartum. The frequency of dizziness and drowsiness within 48 hours also was lower in the hydromorphone group.[ 7 ] A randomized trial allotted women undergoing cesarean section to receive combined spinal-epidural anesthesia with either sufentanil 3 mcg/kg or hydromorphone 0.15 mg/kg plus each group received tropisetron 0.1 mg/kg diluted to 150 mL. The times to first lactation were no different between the groups.[ 8 ]
Levels in milk
In adults, hydromorphone has an oral bioavailability of 62% and is metabolized to inactive metabolites. While not commonly used in infants, an appropriate dose for this age group is 10 mcg/kg parenterally or 30 mcg/kg orally every 4 hours as needed. Maternal Levels. Eight lactating women (time postpartum not given) were given a single 2 mg intranasal dose of hydromorphone. Milk was collected 7 times, beginning 2 hours after and ending 24 hours after the dose. Peak milk levels occurred 2 hours after the dose. The half-life of elimination from milk was 10.5 hours. The reported average milk level, over the 24 hour period after the single dose, was about 1 mcg/L. The authors calculated that an exclusively breastfed infant would receive 0.67% of the maternal weight-adjusted dosage.[ 2 ] Using the average milk level reported in this study, an exclusively breastfed infant would receive 0.15 mcg/kg daily from a single maternal 2 mg intranasal hydromorphone dose. Intranasal hydromorphone is not currently available in the US. Infant Levels. Relevant published information was not found as of the revision date.
Alternatives LactMed lists
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.