Last update Aug. 10, 2022

6-Deoxy-7,8-dihydro-14-hydroxy-6-oxomorphine hydrochloride; (-)-(5R,6S,14S)-4,5-Epoxy-3,14-dihydroxy-9a-methylmorphinan-6-one hydrochloride

Limited compatibility

Unsafe. Moderate/severe adverse effects. Compatible under certain circumstances. Follow-up recommended. Use safer alternative or discontinue breastfeeding from 5 to 7 T ½ . Read Commentary.

It is a potent (8-10 times more powerful than morphine) narcotic analgesic used in the management of moderate to severe pain. It is the active metabolite, and 14 times more potent, of oxycodone (Dalal 2014). Very often used for treatment of pain associated to episiotomy or Cesarean section operation. Oral, subcutaneous or intramuscular administration.

Since the last update we have not found published data on its excretion in breastmilk.

Its pharmacokinetic data (low molecular weight and low percentage of plasma protein binding) makes it likely that significant amounts will pass into breast milk.

On the other hand, its null oral bioavailability makes it difficult for it to pass to the infant plasma from ingested breast milk, except in premature infants and in the immediate neonatal period in which there may be greater intestinal permeability.

Women with some variants of enzyme-linked gene CYP2D6 who are on Oxycodone and their breastfed infants may experience increased sedation. (van den Anker 2012)

Until more published data is known about this drug in relation to breastfeeding, known safer alternatives are preferable, especially during the neonatal period and in the event of prematurity.

Overall, the use of opioids for pain control during labor and another 3 days is compatible with breastfeeding. The duration of opioid treatment should be limited to 3 days in unsupervised outpatient settings. (Ito 2018). Adequately use of nonsteroidal anti-inflammatory drugs (NSAIDs) may attain pain relief with less side effects than with narcotic analgesics.

Alternatives

  • Buprenorphine Hydrochloride (Safe substance and/or breastfeeding is the best option.)
  • Butorphanol Tartrate (Safe substance and/or breastfeeding is the best option.)
  • Ibuprofen (Safe substance and/or breastfeeding is the best option.)
  • Morphine (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
  • Nalbuphine Hydrochloride (Safe substance and/or breastfeeding is the best option.)
  • Paracetamol (Safe substance and/or breastfeeding is the best option.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

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

6-Deoxy-7,8-dihydro-14-hydroxy-6-oxomorphine hydrochloride; (-)-(5R,6S,14S)-4,5-Epoxy-3,14-dihydroxy-9a-methylmorphinan-6-one hydrochloride is Oxymorphone Hydrochloride in Chemical name.

Is written in other languages:

Group

6-Deoxy-7,8-dihydro-14-hydroxy-6-oxomorphine hydrochloride; (-)-(5R,6S,14S)-4,5-Epoxy-3,14-dihydroxy-9a-methylmorphinan-6-one hydrochloride belongs to this group or family:

Tradenames

Main tradenames from several countries containing 6-Deoxy-7,8-dihydro-14-hydroxy-6-oxomorphine hydrochloride; (-)-(5R,6S,14S)-4,5-Epoxy-3,14-dihydroxy-9a-methylmorphinan-6-one hydrochloride in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 10 %
Molecular weight 338 daltons
Protein Binding 12 %
pKa 10.07 -
Tmax 1.9 hours
1.3 ± 0.7 hours

References

  1. Ito S. Opioids in Breast Milk: Pharmacokinetic Principles and Clinical Implications. J Clin Pharmacol. 2018 Oct;58 Suppl 10:S151-S163. Abstract
  2. Dalal PG, Bosak J, Berlin C. Safety of the breast-feeding infant after maternal anesthesia. Paediatr Anaesth. 2014 Abstract
  3. van den Anker JN. Is it safe to use opioids for obstetric pain while breastfeeding? J Pediatr. 2012 Abstract Full text (in our servers)

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