Last update: July 2, 2015

Morphine

Low Risk for breastfeeding


Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
Read the Comment.

Excretion into breast milk is low (even lower when administered through Epidural Anesthesia).

In addition, a low oral bioavailability makes that the amount present in the infant's plasma due to absorption from milk by the gut is low.

Even though, level of drug has been found in the plasma of infants from treated mothers, harmful effects in the infants were not reported.

Levels in the milk are lower and side-effects are fewer among infants whose mothers were treated with Morphine than with Pethidine.

Some authorities consider Morphine as the elective opioid medication for breastfeeding mothers.

Analgesia used during the birth process is related to a brief delayed of stage II of Lactogenesis (milk come-in).

Morphine increases Prolactin level and may decrease Oxytocin level, but it would not be determinant for already established lactations.

Avoidance of repetitive or chronic use and follow-up for somnolence and adequacy of infant nourishment is recommended.

Bed-sharing should be avoid whenever this medication is used by parents.

The American Academy of Pediatrics rates it as compatible with breastfeeding.

Alternatives

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

Morphine in other languages or writings:

Pharmacokinetics

Variable Value Unit
Bioavailability 39 %
Molecular weight 285 daltons
Protein Binding 35 %
Tmax 1 hours
T1/2 2 hours
M/P ratio 5,1 -
Theoretical Dose 0,075 mg/Kg/d
Relative Dose 2,5 - 7,5 %
Relat.Ped.Dose 2,5 - 6,3 %

References

  1. UNICEF UK. Caring for your baby at night. A guide for parents. 2018 Full text (link to original source) Full text (in our servers)
  2. Ball H, Blair PS. (For UNICEF UK). Caring for your baby at night. Health professional´s guide. 2017 Full text (link to original source) Full text (in our servers)
  3. Reece-Stremtan Sarah, Campos Matilde, Kokajko Lauren, and The Academy of Breastfeeding Medicine. Breastfeeding Medicine. ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017. Breastfeeding Medicine. 2017 Full text (link to original source) Full text (in our servers)
  4. Lind JN, Perrine CG, Li R. Relationship between use of labor pain medications and delayed onset of lactation. J Hum Lact. 2014 Abstract
  5. UNICEF UK. Statement on co-sleeping following publication of new NICE postnatal guidance. Infosheet. 2014 Full text (link to original source) Full text (in our servers)
  6. Lind JN, Perrine CG, Li R. Relationship between Use of Labor Pain Medications and Delayed Onset of Lactation. J Hum Lact. 2014 Abstract
  7. Worthington I, Pringsheim T, Gawel MJ, Gladstone J, Cooper P, Dilli E, Aube M, Leroux E, Becker WJ; Canadian Headache Society Acute Migraine Treatment Guideline Development Group. Canadian Headache Society Guideline: acute drug therapy for migraine headache. Can J Neurol Sci. 2013 Abstract Full text (in our servers)
  8. Carvalho FA, Tenório SB. Comparative study between doses of intrathecal morphine for analgesia after caesarean. Braz J Anesthesiol. 2013 Abstract
  9. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  10. D'Apolito K. Breastfeeding and substance abuse. Clin Obstet Gynecol. 2013 Abstract
  11. 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)
  12. UNICEF UK Baby Friendly Initiative statement on Bed-sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case-control studies. 2013 Full text (link to original source) Full text (in our servers)
  13. L.Landa Rivera, M.Díaz-Gómez, A.Gómez Papi, J.M.Paricio Talayero, C.Pallás Alonso, M.T.Hernández Aguilar, J.Aguayo Maldonado, J.M.Arena Ansotegui, S.Ares Segura, A.Jiménez Moya, J.J.Lasarte Velillas, J.Martín Calama, M.D.Romero Escós. El colecho favorece la práctica de la lactancia materna y no aumenta el riesgo de muerte súbita del lactante. Dormir con los padres. Rev Pediatr Aten Primaria. 14:53-60 2012 Full text (link to original source) Full text (in our servers)
  14. Hendrickson RG, McKeown NJ. Is maternal opioid use hazardous to breast-fed infants? Clin Toxicol (Phila). 2012 Abstract Full text (link to original source) Full text (in our servers)
  15. ABM - The Academy of Breastfeeding Medicine Protocol Committee. ABM Clinical Protocol #6: Guideline on Co-Sleeping and Breastfeeding. Breastfeeding Medicine 2008 Abstract Full text (link to original source) Full text (in our servers)
  16. ABM - Comité de protocolos de la Academia médica de lactancia materna (Academy of Breastfeeding Medicine). Protocolo Clínico de la ABM #6: Lineamientos sobre la práctica de dormir al bebé junto con la madre y la lactancia materna Revisión, marzo de 2008. Breastfeeding Medicine 2008 Full text (link to original source) Full text (in our servers)
  17. Young M. Morphine in breast milk. Can Fam Physician. 2007 Abstract Full text (link to original source) Full text (in our servers)
  18. UNICEF UK. Compartiendo la cama con tu bebé. Guía para madres que amamantan. Folleto 2006 Full text (in our servers)
  19. Howie WO, McMullen PC. Breastfeeding problems following anesthetic administration. J Perinat Educ. 2006 Abstract Full text (link to original source) Full text (in our servers)
  20. Moshtaghi-Kashanian GR, Esmaeeli F, Dabiri S. Enhanced prolactin levels in opium smokers. Addict Biol. 2005 Abstract
  21. Yost NP, Bloom SL, Sibley MK, Lo JY, McIntire DD, Leveno KJ. A hospital-sponsored quality improvement study of pain management after cesarean delivery. Am J Obstet Gynecol. 2004 Abstract
  22. Bar-Oz B, Bulkowstein M, Benyamini L, Greenberg R, Soriano I, Zimmerman D, Bortnik O, Berkovitch M. Use of antibiotic and analgesic drugs during lactation. Drug Saf. 2003 Abstract
  23. Baka NE, Bayoumeu F, Boutroy MJ, Laxenaire MC. Colostrum morphine concentrations during postcesarean intravenous patient-controlled analgesia. Anesth Analg. 2002 Abstract
  24. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  25. 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)
  26. Oberlander TF, Robeson P, Ward V, Huckin RS, Kamani A, Harpur A, McDonald W. Prenatal and breast milk morphine exposure following maternal intrathecal morphine treatment. J Hum Lact. 2000 Abstract
  27. Spigset O, Hägg S. Analgesics and breast-feeding: safety considerations. Paediatr Drugs. 2000 Abstract
  28. 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)
  29. Lindow SW, Hendricks MS, Nugent FA, Dunne TT, van der Spuy ZM. Morphine suppresses the oxytocin response in breast-feeding women. Gynecol Obstet Invest. 1999 Abstract
  30. Wittels B, Glosten B, Faure EA, Moawad AH, Ismail M, Hibbard J, Senal JA, Cox SM, Blackman SC, Karl L, Thisted RA. Postcesarean analgesia with both epidural morphine and intravenous patient-controlled analgesia: neurobehavioral outcomes among nursing neonates. Anesth Analg. 1997 Abstract
  31. Ravin DS. Narcotic analgesics and breastfeeding. J Hum Lact. 1995 Abstract
  32. Meny RG, Naumburg EG, Alger LS, Brill-Miller JL, Brown S. Codeine and the breastfed neonate. J Hum Lact. 1993 Abstract
  33. Zakowski MI, Ramanathan S, Turndorf H. A two-dose epidural morphine regimen in cesarean section patients: pharmacokinetic profile. Acta Anaesthesiol Scand. 1993 Abstract
  34. Robieux I, Koren G, Vandenbergh H, Schneiderman J. Morphine excretion in breast milk and resultant exposure of a nursing infant. J Toxicol Clin Toxicol. 1990 Abstract
  35. Wittels B, Scott DT, Sinatra RS. Exogenous opioids in human breast milk and acute neonatal neurobehavior: a preliminary study. Anesthesiology. 1990 Abstract
  36. Feilberg VL, Rosenborg D, Broen Christensen C, Mogensen JV. Excretion of morphine in human breast milk. Acta Anaesthesiol Scand. 1989 Abstract
  37. Zis AP, Haskett RF, Albala AA, Carroll BJ. Morphine inhibits cortisol and stimulates prolactin secretion in man. Psychoneuroendocrinology. 1984 Abstract
  38. Tolis G, Hickey J, Guyda H. Effects of morphine on serum growth hormone, cortisol, prolactin and thyroid stimulating hormone in man. J Clin Endocrinol Metab. 1975 Abstract

Total visits

52,783

Help us improve this entry

How to cite this entry

Do you need more information or did not found what you were looking for?

   Write to us at elactancia.org@gmail.com

e-lactancia is a resource recommended by Instituto de Salud Infantil, Grecia-Institute of Child's Health in Greece

Would you like to recommend the use of e-lactancia? Write to us at corporate mail of APILAM