Last update March 6, 2022

Cocaine

Very High Risk

Very unsafe. Contraindicated. Use of an alternative or cessation of breastfeeding. Read the Comment.

Infants exposed to cocaine during pregnancy had a lower gestational age, lower weight, height, and head circumference, more tremors, irritability, and infections, less frequent breastfeeding, and a higher risk of developmental delay, sudden death, social problems. and child neglect, than the unexposed. (Maya 2021, Bauer2005, Young 1992)

Cocaine and its metabolites are excreted in breast milk (Dos Santos 2017, Silveira 2016, D'Avila 2015, D'Apolito 2013, Marchei 2011, Winecker 2001, Bailey 1998, Dickson 1997, Chasnoff 1987). Its low molecular weight, high lipid solubility, and binding to breast milk albumin facilitate the observed excretion in breast milk.

The infants are also exposed to accidental ingestion and passive inhalation of cocaine vapors (crack). (Kharasch 1991, Heidemann 1990, Bateman 1989)

Reportedly, cases of irritability, tremulousness, hypotonia, vomiting, diarrhea, dilated pupils, cyanosis, respiratory distress, tachycardia and arterial hypertension in infants whose mothers had taken this drug have occurred. (Sachs 2013, Joya 2011, Chasnoff 1987)

Newborn and infants eliminate cocaine much more slowly than adults (Moretti 2000). Cocaine is detected in urine of infants until 60 hours after a breast feed. (Chasnoff 1987)

Applying cocaine on mother's nipple as anesthetic is highly hazardous since seizures, lethargy or coma may occur. (Howie 2006, Lee 1993, Chaney 1988)

Drug abuse behavior incapacitates the mother for appropriate baby care and poses a life and health hazard for both, the mother and the infant. There is an increased risk of psychosis and other psychiatric disorders in mothers who use drugs such as cocaine. (Vallersnes 2016, Gerra 2009)

After exceptional cocaine consumption a free period of 24 hours should be observed before resuming breastfeeding. (Cressman 2012)

Some authors recommend continuing breastfeeding if cocaine use is not habitual, monitoring the levels of cocaine in breast milk and urine of the infant and controlling the clinical status of the infant. (Sarqar 2005)

Bed-sharing with the baby is not recommended if drugs are used due to increased risk of suffocation or sudden infant death. (ABM 2020 &2008, UNICEF 2019, 2017, 2014 & 2013, Landa 2012, UNICEF 2006)

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

Cocaine is also known as


Cocaine in other languages or writings:

Tradenames

Main tradenames from several countries containing Cocaine in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. nasal. 80; oral. 90 %
Molecular weight 303 daltons
Protein Binding 91 %
VD 1.6 - 2.7 l/Kg
pKa 8.85 -
Tmax 0.9 - 1.5 hours
1 hours
Theoretical Dose 0.02 - 0.07 mg/Kg/d
Relative Dose 1.62 %

References

  1. Maya-Enero S, Guarddon Pueyo C, Mur-Sierra A, López-Vílchez MÁ. Drug abuse during pregnancy and its neonatal impact. Analysis of the periods 2002-2008 and 2009-2017. Med Clin (Barc). 2021 Aug 27;157(4):159-163. Abstract
  2. UNICEF UK. Caring for your baby at night. A guide for parents. 2018 Full text (link to original source) Full text (in our servers)
  3. Dos Santos RR, Nunes Paiva MJ, Veloso JC, Serp P, Lourdes Cardeal Z, Menezes HC. Efficient extraction method using magnetic carbon nanotubes to analyze cocaine and benzoylecgonine in breast milk by GC/MS. Bioanalysis. 2017 Nov;9(21):1655-1666. Abstract
  4. UNICEF. 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)
  5. Silveira Gde O, Belitsky ÍT, Loddi S, Rodrigues de Oliveira CD, Zucoloto AD, Fruchtengarten LV, Yonamine M. Development of a method for the determination of cocaine, cocaethylene and norcocaine in human breast milk using liquid phase microextraction and gas chromatography-mass spectrometry. Forensic Sci Int. 2016 Aug;265:22-8. Abstract
  6. Vallersnes OM, Dines AM, Wood DM, Yates C, Heyerdahl F, Hovda KE, Giraudon I; Euro-DEN Research Group., Dargan PI. Psychosis associated with acute recreational drug toxicity: a European case series. BMC Psychiatry. 2016 Aug 18;16:293. Abstract Full text (link to original source)
  7. D'Avila FB, Pereira AG, Salazar FR, Ferreira PL, Salazar CR, Limberger RP, Fröehlich PE. Determination of cocaine/crack biomarkers in colostrum by LC-MS following protein precipitation. J Pharm Biomed Anal. 2015 Jan 25;103:67-72. Abstract
  8. ABM. 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)
  9. 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)
  10. 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)
  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. D'Apolito K. Breastfeeding and substance abuse. Clin Obstet Gynecol. 2013 Mar;56(1):202-11. Abstract
  13. 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. None 2013 Full text (link to original source) Full text (in our servers)
  14. Cressman AM, Koren G, Pupco A, Kim E, Ito S, Bozzo P. Maternal cocaine use during breastfeeding. Can Fam Physician. 2012 Abstract Full text (link to original source) Full text (in our servers)
  15. 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)
  16. Joya X, Fríguls B, Simó M, Civit E, de la Torre R, Palomeque A, Vall O, Pichini S, Garcia-Algar O. Acute heroin intoxication in a baby chronically exposed to cocaine and heroin: a case report. J Med Case Rep. 2011 Abstract Full text (link to original source) Full text (in our servers)
  17. Marchei E, Escuder D, Pallas CR, Garcia-Algar O, Gómez A, Friguls B, Pellegrini M, Pichini S. Simultaneous analysis of frequently used licit and illicit psychoactive drugs in breast milk by liquid chromatography tandem mass spectrometry. J Pharm Biomed Anal. 2011 May 15;55(2):309-16. Abstract
  18. Gerra G, Leonardi C, Cortese E, Zaimovic A, Dell'agnello G, Manfredini M, Somaini L, Petracca F, Caretti V, Raggi MA, Donnini C. Childhood neglect and parental care perception in cocaine addicts: relation with psychiatric symptoms and biological correlates. Neurosci Biobehav Rev. 2009 Abstract
  19. 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)
  20. 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)
  21. UNICEF UK. Compartiendo la cama con tu bebé. Guía para madres que amamantan. Folleto 2006 Full text (in our servers)
  22. 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)
  23. Bauer CR, Langer JC, Shankaran S, Bada HS, Lester B, Wright LL, Krause-Steinrauf H, Smeriglio VL, Finnegan LP, Maza PL, Verter J. Acute neonatal effects of cocaine exposure during pregnancy. Arch Pediatr Adolesc Med. 2005 Abstract Full text (link to original source) Full text (in our servers)
  24. Sarkar M, Djulus J, Koren G; Motherisk Program, Division of Clinical Parmacology/Toxicology, The Hospital fr Sick Children, University of Toronto,Ontario, Canada. When a cocaine-using mother wishes to breastfeed: proposed guidelines. Ther Drug Monit. 2005 Abstract
  25. Winecker RE, Goldberger BA, Tebbett IR, Behnke M, Eyler FD, Karlix JL, Wobie K, Conlon M, Phillips D, Bertholf RL. Detection of cocaine and its metabolites in breast milk. J Forensic Sci. 2001 Abstract
  26. 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)
  27. Bailey DN. Cocaine and cocaethylene binding to human milk. Am J Clin Pathol. 1998 Abstract
  28. Dickson PH, Lind A, Studts P, Nipper HC, Makoid M, Therkildsen D. The routine analysis of breast milk for drugs of abuse in a clinical toxicology laboratory. J Forensic Sci. 1994 Jan;39(1):207-14. Abstract
  29. Lee JJ, Rubin AP. Breast feeding and anaesthesia. Anaesthesia. 1993 Jul;48(7):616-25. Review. Abstract Full text (link to original source) Full text (in our servers)
  30. Young SL, Vosper HJ, Phillips SA. Cocaine: its effects on maternal and child health. Pharmacotherapy. 1992 Abstract
  31. Kharasch SJ, Glotzer D, Vinci R, Weitzman M, Sargent J. Unsuspected cocaine exposure in young children. Am J Dis Child. 1991 Feb;145(2):204-6. Abstract
  32. Heidemann SM, Goetting MG. Passive inhalation of cocaine by infants. Henry Ford Hosp Med J. 1990;38(4):252-4. Abstract
  33. Bateman DA, Heagarty MC. Passive freebase cocaine ('crack') inhalation by infants and toddlers. Am J Dis Child. 1989 Abstract
  34. Chaney NE, Franke J, Wadlington WB. Cocaine convulsions in a breast-feeding baby. J Pediatr. 1988 Abstract
  35. Chasnoff IJ, Lewis DE, Squires L. Cocaine intoxication in a breast-fed infant. Pediatrics. 1987 Abstract

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