Last update: March 29, 2016

Methadone Hydrochloride

Very Low Risk for breastfeeding


Safe. Compatible.
Not risky for breastfeeding or infant.

Drugs used in the treatment of opioid dependence and treatment of neonatal opiate withdrawal.

It is excreted in breast milk in clinically non-significant amount without problems in the short or long term in infants whose mothers were treated. Plasma levels of these infants were undetectable or very low.
The dose that gets the infant through the mother's milk, even when taking 70-150 mg a-day, is much lower than that used to treat neonatal abstinence syndrome. This is a reason for not using it as a solely measure of treatment.

It should be reinforced that it is observed a non-polydrug behavior and adequacy of maternal care is maintained. Many newborns are either premature or underweight infants, and over 60% develop withdrawal syndrome at about one post-natal month. Breastfeeding with regard to the entire context of addictive behavior is neither easy nor frequently achieved. Much help is needed on supporting addicted mothers by health and social services in the community.

Methadone excretion into breast milk is minimal regardless of the dose taken by the mother. No correlation was found between maternal dose and concentration in either breast milk or infant plasma.
It has been shown delayed onset of neonatal abstinence syndrome, less need for drug treatment and lower average of hospital stay in breastfed infants.
High doses can lead to a slow start (within 2-6 weeks) of withdrawal syndrome when breastfeeding is suddenly stopped.

Methadone can cause galactorrhea due to increased prolactin secretion.

Alternatives

We do not have alternatives for Methadone Hydrochloride since it is relatively safe.

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Methadone Hydrochloride is also known as


Methadone Hydrochloride in other languages or writings:

Groups

Methadone Hydrochloride belongs to these groups or families:

Tradenames

Main tradenames from several countries containing Methadone Hydrochloride in its composition:

Pharmacokinetics

Variable Value Unit
Bioavailability 90 %
Molecular weight 310 daltons
Protein Binding 60 - 90 %
VD 4,1 l/Kg
Tmax 1,5 - 5 hours
T1/2 15 - 60 hours
M/P ratio 0,7 - 1,2 -
Theoretical Dose 0,02 - 0,08 mg/Kg/d
Relative Dose 1,2 - 7 %
Relat.Ped.Dose 8 %

References

  1. Reece-Stremtan S, Marinelli KA. ABM Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder, Revised 2015. Breastfeed Med. 2015 Abstract Full text (link to original source) Full text (in our servers)
  2. Lefevere J, Allegaert K. Question: is breastfeeding useful in the management of neonatal abstinence syndrome? Arch Dis Child. 2015 Abstract
  3. ABM Protocolo clínico de la ABM n.º 21: Pautas para la lactancia y el consumo de sustancias o trastorno por consumo de sustancias, revisado en 2015. Breastfeed Med. 2015 Full text (link to original source) Full text (in our servers)
  4. Kocherlakota P. Neonatal abstinence syndrome. Pediatrics. 2014 Abstract Full text (link to original source) Full text (in our servers)
  5. Sutter MB, Leeman L, Hsi A. Neonatal opioid withdrawal syndrome. Obstet Gynecol Clin North Am. 2014 Abstract
  6. Bagley SM, Wachman EM, Holland E, Brogly SB. Review of the assessment and management of neonatal abstinence syndrome. Addict Sci Clin Pract. 2014 Abstract Full text (link to original source) Full text (in our servers)
  7. Sachs HC; Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013 Sep;132(3):e796-809. Abstract Full text (link to original source) Full text (in our servers)
  8. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  9. D'Apolito K. Breastfeeding and substance abuse. Clin Obstet Gynecol. 2013 Abstract
  10. Logan BA, Brown MS, Hayes MJ. Neonatal abstinence syndrome: treatment and pediatric outcomes. Clin Obstet Gynecol. 2013 Abstract Full text (link to original source) Full text (in our servers)
  11. Welle-Strand GK, Skurtveit S, Jansson LM, Bakstad B, Bjarkø L, Ravndal E. Breastfeeding reduces the need for withdrawal treatment in opioid-exposed infants. Acta Paediatr. 2013 Abstract
  12. Mehta A, Forbes KD, Kuppala VS. Neonatal Abstinence Syndrome Management From Prenatal Counseling to Postdischarge Follow-up Care: Results of a National Survey. Hosp Pediatr. 2013 Abstract Full text (link to original source) Full text (in our servers)
  13. Pritham UA, Paul JA, Hayes MJ. Opioid dependency in pregnancy and length of stay for neonatal abstinence syndrome. J Obstet Gynecol Neonatal Nurs. 2012 Abstract Full text (link to original source) Full text (in our servers)
  14. ACOG Committee on Health Care for Underserved Women; American Society of Addiction Medicine. ACOG Committee Opinion No. 524: Opioid abuse, dependence, and addiction in pregnancy. Obstet Gynecol. 2012 Abstract
  15. Hodgson ZG, Abrahams RR. A rooming-in program to mitigate the need to treat for opiate withdrawal in the newborn. J Obstet Gynaecol Can. 2012 Abstract
  16. Bogen DL, Perel JM, Helsel JC, Hanusa BH, Thompson M, Wisner KL. Estimated infant exposure to enantiomer-specific methadone levels in breastmilk. Breastfeed Med. 2011 Abstract Full text (link to original source) Full text (in our servers)
  17. McQueen KA, Murphy-Oikonen J, Gerlach K, Montelpare W. The impact of infant feeding method on neonatal abstinence scores of methadone-exposed infants. Adv Neonatal Care. 2011 Abstract
  18. Isemann B, Meinzen-Derr J, Akinbi H. Maternal and neonatal factors impacting response to methadone therapy in infants treated for neonatal abstinence syndrome. J Perinatol. 2011 Abstract
  19. Wachman EM, Byun J, Philipp BL. Breastfeeding rates among mothers of infants with neonatal abstinence syndrome. Breastfeed Med. 2010 Abstract
  20. Dryden C, Young D, Hepburn M, Mactier H. Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources. BJOG. 2009 Abstract Full text (link to original source) Full text (in our servers)
  21. Jansson LM, Choo R, Velez ML, Harrow C, Schroeder JR, Shakleya DM, Huestis MA. Methadone maintenance and breastfeeding in the neonatal period. Pediatrics. 2008 Abstract
  22. Jansson LM, Choo R, Velez ML, Lowe R, Huestis MA. Methadone maintenance and long-term lactation. Breastfeed Med. 2008 Abstract Full text (link to original source) Full text (in our servers)
  23. Jansson LM, Choo RE, Harrow C, Velez M, Schroeder JR, Lowe R, Huestis MA. Concentrations of methadone in breast milk and plasma in the immediate perinatal period. J Hum Lact. 2007 Abstract Full text (link to original source) Full text (in our servers)
  24. Miles J, Sugumar K, Macrory F, Sims DG, D'Souza SW. Methadone-exposed newborn infants: outcome after alterations to a service for mothers and infants. Child Care Health Dev. 2007 Abstract
  25. Abdel-Latif ME, Pinner J, Clews S, Cooke F, Lui K, Oei J. Effects of breast milk on the severity and outcome of neonatal abstinence syndrome among infants of drug-dependent mothers. Pediatrics. 2006 Abstract
  26. Bennett J, Whale R. Galactorrhoea may be associated with methadone use. BMJ. 2006 Abstract Full text (link to original source) Full text (in our servers)
  27. Arlettaz R, Kashiwagi M, Das-Kundu S, Fauchère JC, Lang A, Bucher HU. Methadone maintenance program in pregnancy in a Swiss perinatal center (II): neonatal outcome and social resources. Acta Obstet Gynecol Scand. 2005 Abstract
  28. Jansson LM, Velez M, Harrow C. Methadone maintenance and lactation: a review of the literature and current management guidelines. J Hum Lact. 2004 Abstract
  29. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Abstract Full text (link to original source) Full text (in our servers)
  30. Begg EJ, Malpas TJ, Hackett LP, Ilett KF. Distribution of R- and S-methadone into human milk during multiple, medium to high oral dosing. Br J Clin Pharmacol. 2001 Abstract Full text (link to original source) Full text (in our servers)
  31. Moretti ME, Lee A, Ito S. Which drugs are contraindicated during breastfeeding? Practice guidelines. Can Fam Physician. 2000 Sep;46:1753-7. Review. Abstract Full text (link to original source) Full text (in our servers)
  32. McCarthy JJ, Posey BL. Methadone levels in human milk. J Hum Lact. 2000 Abstract
  33. Malpas TJ, Darlow BA. Neonatal abstinence syndrome following abrupt cessation of breastfeeding. N Z Med J. 1999 Abstract
  34. Geraghty B, Graham EA, Logan B, Weiss EL. Methadone levels in breast milk. J Hum Lact. 1997 Abstract
  35. Wojnar-Horton RE, Kristensen JH, Yapp P, Ilett KF, Dusci LJ, Hackett LP. Methadone distribution and excretion into breast milk of clients in a methadone maintenance programme. Br J Clin Pharmacol. 1997 Abstract Full text (link to original source) Full text (in our servers)
  36. Kreek MJ. Methadone disposition during the perinatal period in humans. Pharmacol Biochem Behav. 1979 Abstract
  37. Kreek MJ, Schecter A, Gutjahr CL, Bowen D, Field F, Queenan J, Merkatz I. Analyses of methadone and other drugs in maternal and neonatal body fluids: use in evaluation of symptoms in a neonate of mother maintained on methadone. Am J Drug Alcohol Abuse. 1974 Abstract

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