Pain medications and breastfeeding

August 1, 2011. Posted in: Medications & Vaccines

Info on selected pain medications

The information summarized below is only a general overview of selected pain medications. For detailed information on the specific drugs or for information on drugs not listed here, please review the references listed below with your health care provider.

Info on selected medications used for pain relief
Name of medication
AAP approved?*
Pregnancy Risk Category**
Notes
Acetaminophen
(Tylenol)
Approved
B
L1
Aspirin
Caution
C (1st, 2nd trim.)
D (3rd trim.)
L3
Azapropazone
(Rheumox)
Approved
- L2
Butalbital
(Fioricet, Fiorinal, Bancap, Two-dyne)
NR D L3 2
Butorphanol
(Stadol)
Approved
B (1st, 2nd trim.)
D (3rd trim.)
L3
Celecoxib
(Celebrex) (FDA safety info)
NR C L2
Codeine
(in Tylenol #3, #4)
Approved
C
L3
Colchicine
Approved
D L4
Diclofenac
(Cataflam, Voltaren)
NR B L2
Fentanyl
(Sublimaze)
Approved
B L2
Flurbiprofen
(Ansaid, Froben, Ocufen)
NR B (1st, 2nd trim.)
C (3rd trim.)
L2
Hydrocodone
(Lortab, Vicodin)
NR B L3 4
Hydromorphone
(Dilaudid)
NR C L3 5
Ibuprofen
(Advil, Nuprin, Motrin, Pediaprofen)
Approved
B (1st, 2nd trim.)
D (3rd trim.)
L1
Indomethacin
(Indocin)
Approved
B (1st, 2nd trim.)
D (3rd trim.)
L3
Ketorolac
(Toradol, Acular)
Approved
B (1st, 2nd trim.)
D (3rd trim.)
L2
Meperidine
(Demerol)
Approved
B L2;
L3 early postpartum
6
Methadone
(Dolophine)
Approved
B L3 7
Morphine
(Duramorph, Infumorph, Epimorph, MS Contin)
Approved
B L3 8
Nalbuphine
(Nubain)
NR B L2
Naproxen
(Anaprox, Naprosyn, Naproxen, Aleve)
Approved
B
L3;
L4 for chronic use
Nefopam
(Acupan)
Approved
-
NR
Oxycodone
(Tylox, Percodan,Oxycontin, Roxicet, Endocet, Roxiprin, Percocet)
NR B L3 10
Pentosan polysulfate
(Elmiron)
NR B L2
Piroxicam
(Feldene)
Approved
B L2
Propoxyphene
(Darvocet N, Propacet, Darvon)
Approved
C L2 11
Rofecoxib
(Vioxx)
Withdrawn from the market 12
Secobarbital
(Seconal)
Approved
D L3 13
Tolmetin
(Tolectin)
Approved
C L3
Tramadol HCL
(Ultram, Ultracet)
NR C L3 14
Valdecoxib
(Bextra) (FDA safety info)
Withdrawn from the market more
*  Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.

** Per Medications’ and Mothers’ Milk by Thomas Hale, PhD (2004 edition).

 Lactation Risk Categories  Pregnancy Risk Categories
  • L1 (safest)
  • L2 (safer)
  • L3 (moderately safe)
  • L4 (possibly hazardous)
  • L5 (contraindicated)
  • A (controlled studies show no risk)
  • B (no evidence of risk in humans)
  • C (risk cannot be ruled out)
  • D (positive evidence of risk)
  • X (contraindicated in pregnancy)
NR: Not Reviewed. This drug has not yet been reviewed by Hale.
  1. Aspirin use is discouraged in children and nursing mothers due to the risk of Reye’s syndrome and internal bleeding.
  2. Fioricet (Fiorinal, Bancap, Two-dyne) contains acetaminaphen or asprin, caffeine, and butalbital. Per Hale, baby should be observed for sedation.
  3. Hale suggests weakened or premature infants be observed for sedation and apnea.
  4. Hale suggests newborns be observed for sedation, apnea, constipation.
  5. Per Hale, use of frequent, higher dose may result in infant sedation.
  6. Per Hale, Meperidine use during labor or early postpartum has been associated with sedation, poor sucking reflex, and neurobehavioral delay in infants.
  7. Per Hale, observe infant for sedation, respiratory depression, addiction, withdrawal syndrome.
  8. Per Hale, higher doses may result in infant sedation.
  9. Per Hale, should be used with caution due to its long half-life and its effect on baby’s cardiovascular system, kidneys and GI tract; short-term, infrequent or occasional use is not necessarily incompatible with breastfeeding.
  10. Roxicet, Endocet, Roxiprin, Percocet also contain acetaminophen. Per Hale, observe infant for sedation.
  11. Per Hale, observe infant for sedation.
  12. Per Hale, observe infant for GI cramping, distress, diarrhea.
  13. Per Hale, observe infant for sedation.
  14. Per Hale, observe infant for sedation.
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References

Table 6: Maternal Medication Usually Compatible With Breast-Feeding, from the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.

Hale, Thomas. Medications and Mothers’ Milk, 11th Edition. Pharmasoft Medical Publishing, 2004. Dr. Hale’s website is located at http://neonatal.ttuhsc.edu/lact/index.html.

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Links for additional information

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