Is Remifentanil safe while breastfeeding?

Effects on the breastfed infant

Four mothers who were breastfeeding their infants received remifentanil as part of their general anesthesia for surgical procedures. All patients also received intravenous propofol and rocuronium, and inhaled xenon as part of the anesthesia. They were given doses of remifentanil that targeted a serum concentration of 4.5 mcg/L during the procedure and reduced to achieve a target concentration of 1.5 mcg/L at the end of anesthesia. Individual infants were first breastfed as follows: 1.5 hours, 2.8 hours, 4.6 hours, and 5 hours after extubation. No signs of sedation were observed in any of the infants.[ 1 ]

Effects on milk supply

Narcotics can increase serum prolactin.[ 2 , 3 ] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed. A double-blind, randomized study compared patient-controlled intravenous (IV) analgesia with remifentanil (n = 43) to a continuous meperidine infusion (n = 45) for labor analgesia. Patients receiving remifentanil used an average total dosage of 1035 mcg/kg and those receiving meperidine received an average total dosage of 150 mg/kg. Breastfeeding difficulties were experienced in 6.3% of the infants of mothers who received remifentanil and 12.8% of infants whose mothers received meperidine; however, this difference was not statistically significant.[ 4 ]

Levels in milk

Remifentanil is administered intravenously and has a half-life of about 3 minutes in adults. Its oral bioavailability is unknown. Maternal Levels. Relevant published information was not found as of the revision date. Infant Levels. Relevant published information was not found as of the revision date.

Alternatives LactMed lists

• Butorphanol
• Fentanyl
• Hydromorphone
• Morphine