Can I take morphine while pregnant or breastfeeding?

8.1 Pregnancy Risk Summary Use of opioid analgesics for an extended period of time during pregnancy may cause neonatal withdrawal syndrome [see Warnings and Precautions ( 5.4 )] . There are no available data with morphine sulfate extended-release tablets in pregnant women to inform a drug-associated risk for major birth defects and miscarriage.

Prescribing label, section “8.1 Pregnancy” (opening excerpt): Morphine Sulfate (oral), SpecGx LLC. Read the full section on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.

Epidural morphine given to mothers for postcesarean section analgesia results in trivial amounts of morphine in their colostrum and milk. Intravenous or oral doses of maternal morphine in the immediate postpartum period result in higher milk levels than with epidural morphine. Labor pain medication may delay the onset of lactation. Maternal use of oral opioids during breastfeeding can cause infant drowsiness, which may progress to rare but severe central nervous system depression, although low-dose morphine might be preferred over other opiates.[1,2] Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Extended-release morphine products (such as MSContin) are not recommended in nursing mothers. If morphine is required by the mother of a newborn, it is not a reason to discontinue breastfeeding; however, once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of morphine to 2 to 3 days at a low dosage with close infant monitoring, especially in the outpatient setting.[3] If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness during maternal morphine use, a physician should be contacted immediately. Withdrawal symptoms can occur in breastfed infants when maternal administration of an opioid analgesic is stopped, or when breastfeeding is stopped.

Some evidence suggests that IV ketorolac, oral ibuprofen and acetaminophen as part of a multimodal post-cesarean section analgesia reduces percentage of mothers who fail exclusive breastfeeding compared to patient-controlled IV morphine-based analgesia.[4]

“Summary of Use during Lactation”, LactMed record “Morphine” (LM370), quoted verbatim. Everything LactMed reports about Morphine while breastfeeding.

8.2 Lactation Risk Summary Morphine is present in breast milk. Published lactation studies report variable concentrations of morphine in breast milk with administration of immediate-release morphine to nursing mothers in the early postpartum period with a milk-to-plasma morphine AUC ratio of 2.5:1 measured in one lactation study. However, there is insufficient information to determine the effects of morphine on the breastfed infant and the effects of morphine on milk production. Lactation studies have not been conducted with extended-release morphine, including morphine sulfate extended-release tablets. Because of the potential for serious adverse reactions, including excess sedation and respiratory depression in a breastfed infant, advise patients that breastfeeding is not recommended during treatment with morphine sulfate extended-release tablets. Clinical Considerations Monitor infants exposed to morphine sulfate extended-release tablets through breast milk for excess sedation and respiratory depression. Withdrawal symptoms can occur in breastfed infants when maternal administration of an opioid analgesic is stopped, or when breastfeeding is stopped.

Prescribing label, section “8.2 Lactation”: Morphine Sulfate (oral), SpecGx LLC. Label on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.