Last update July 11, 2022

Fentanyl

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

It is a potent opioid analgesic chemically related to pethidine that is used in anesthesia and for the control of pain (cancer and chronic intractable). Several ways of administration: epidural, intravenous, intramuscular, intranasal, sublingual (transmucosal) or transdermal (patches). 

It is excreted into breast milk in undetectable or non-significant amount (Cohen 2009, Goma 2008, Nitsun 2006, Steer 1992, Leuschen 1990, Madej 1987)

Overall no problems have been observed among infants from treated mothers (Cohen 2009). A 17-month-old infant whose mother received fentanyl, morphine, oxycodone, and benzodiazepines had lethargy/irritability, cyanosis, tachycardia, and respiratory depression that were reversed by naloxone. (Beauchamp 2019)

Plasma levels in one infant were undetectable. (Cohen 2009)

It has been authorized for treatment of small infants and neonates.

Fentanyl has a very low oral availability. After a mother has underwent anesthesia by the use of Fentanyl, she may breastfeed her baby as soon as her recovery and general conditions may permit it. (Reece 2017, ASGE 2012)

Fentany has lesser effect than Pethidine (Demerol) on initiation of breastfeeding. (Fleet 2015)

Fentanyl stimulates secretion of Prolactin, however, after Lactation has been established, Prolactin level has a poor relationship with production of mother's milk.

There is controversy (Szabo 2013, Reynolds 2011, Camann 2007, Halpern 2005) about the effect of analgesic medication used for labor management (Epidural anesthesia with Fentanyl added or not ) on the initiation and/or the duration of breastfeeding:

  • A delay in the initiation of Lactogenesis II (milk coming in), delayed initiation of lactation, lower frequency and shorter duration of lactation have been found, particularly in mothers who had received high doses (>150-200 micrograms) of epidural fentanyl and in primiparous. (Oommen 2021, Orbach 2019, Herrera 2015, Brimdyr 2015, Lind 2014, Beilin 2005, Jordan 2005)
  • Other studies have found no statistically or clinically significant differences. (Fan 2020, Mahomed 2019, Fleet 2014, Zuppa 2014, Shrestha 2014, ​​​Gizzo 2012, Wieczorek 2010, Wilson 2010, Cohen 2009, Goma 2008, Chang 2005, Wang 2005, Radzyminski 2003)

It appears to be of more paramount importance the women's support for the establishment and continuation of breastfeeding, than the negative effect that would be exerted by administration of analgesia or anesthesia during labor.
 (Zuppa 2014, Torvaldsen 2006)

It occurs a higher milk production and weight increase of the infant if there is an adequate pharmacological control of the pain that appears after vaginal birth or C-section. (Wang 2005)

Several medical societies and expert authors consider the use of this medication possible during breastfeeding. (Hale, Briggs 2015, Schaefer 2015, AGA 2012, ASGE 2012, Howie 2006, Mahadevan 2006, Nice 2004, Lee 1993)

The American Academy of Pediatrics says that is usually compatible with breastfeeding. (AAP 2001)

Alternatives

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

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

Fentanyl is also known as


Fentanyl in other languages or writings:

Groups

Fentanyl belongs to these groups or families:

Tradenames

Main tradenames from several countries containing Fentanyl in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 33 -76 %
Molecular weight 337 daltons
Protein Binding 80- 85 %
VD 4 - 8 l/Kg
Tmax 0.3 - 1.5 (transderm: 3.6) hours
5-12; iv: 2-4; nas: 15-25 hours
M/P ratio 2.1 -
Theoretical Dose 0.00002 -0.001 mg/Kg/d
Relative Dose 0.38 - 1.2 %
Ped.Relat.Dose 0.1 - 0.3 %

References

  1. Oommen H, Oddbjørn Tveit T, Eskedal LT, Myr R, Swanson DM, Vistad I. The association between intrapartum opioid fentanyl and early breastfeeding: A prospective observational study. Acta Obstet Gynecol Scand. 2021 Dec;100(12):2294-2302. Consulted on April 22, 2021 Abstract
  2. Fan HSL, Wong JYH, Fong DYT, Lok KYW, Tarrant M. Association Between Intrapartum Factors and the Time to Breastfeeding Initiation. Breastfeed Med. 2020 Jun;15(6):394-400. Consulted on June 22, 2020 Abstract
  3. Mahomed K, Wild K, Brown C, Green A. Does fentanyl epidural analgesia affect breastfeeding: A prospective cohort study. Aust N Z J Obstet Gynaecol. 2019 Apr 8. Abstract
  4. Beauchamp GA, Hendrickson RG, Horowitz BZ, Spyker DA. Exposures Through Breast Milk: An Analysis of Exposure and Information Calls to U.S. Poison Centers, 2001-2017. Breastfeed Med. 2019 Sep;14(7):508-512. Abstract
  5. Orbach-Zinger S, Landau R, Davis A, Oved O, Caspi L, Fireman S, Fein S, Ioscovich A, Bracco D, Hoshen M, Eidelman LA. The Effect of Labor Epidural Analgesia on Breastfeeding Outcomes: A Prospective Observational Cohort Study in a Mixed-Parity Cohort. Anesth Analg. 2018 May 25. Abstract
  6. 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. Breastfeed Med. 2017 Nov;12(9):500-506. Full text (link to original source) Full text (in our servers)
  7. Brimdyr K, Cadwell K, Widström AM, Svensson K, Neumann M, Hart EA, Harrington S, Phillips R. The Association Between Common Labor Drugs and Suckling When Skin-to-Skin During the First Hour After Birth. Birth. 2015 Dec;42(4):319-28. Abstract
  8. Herrera-Gómez A, García-Martínez O, Ramos-Torrecillas J, De Luna-Bertos E, Ruiz C, Ocaña-Peinado FM. Retrospective study of the association between epidural analgesia during labour and complications for the newborn. Midwifery. 2015 Jun;31(6):613-6. Abstract
  9. Fleet J, Belan I, Jones M, Ullah S, Cyna A. A comparison of fentanyl with pethidine for pain relief during childbirth: a randomised controlled trial. BJOG. 2015 Abstract
  10. Fleet J, Jones M, Belan I. Subcutaneous administration of fentanyl in childbirth: an observational study on the clinical effectiveness of fentanyl for mother and neonate. Midwifery. 2014 Abstract Full text (link to original source) Full text (in our servers)
  11. Dalal PG, Bosak J, Berlin C. Safety of the breast-feeding infant after maternal anesthesia. Paediatr Anaesth. 2014 Abstract
  12. Lind JN, Perrine CG, Li R. Relationship between Use of Labor Pain Medications and Delayed Onset of Lactation. J Hum Lact. 2014 Abstract Full text (link to original source)
  13. Shrestha B, Devgan A, Sharma M. Effects of maternal epidural analgesia on the neonate - a prospective cohort study. Ital J Pediatr. 2014 Abstract Full text (link to original source) Full text (in our servers)
  14. Zuppa A, Alighieri G, Riccardi R, Cavani M, Iafisco A, Cota F, Romagnoli C. Epidural analgesia, neonatal care and breastfeeding. Ital J Pediatr. 2014 Abstract Full text (link to original source) Full text (in our servers)
  15. Szabo AL. Review article: Intrapartum neuraxial analgesia and breastfeeding outcomes: limitations of current knowledge. Anesth Analg. 2013 Abstract
  16. AGA - American Association for the Study of Liver Diseases; American College of Gastroenterology; American Gastroenterological Association Institute; American Society for Gastrointestinal Endoscopy; Society for Gastroenterology Nurses and Associates, Vargo JJ, DeLegge MH, Feld AD, Gerstenberger PD, Kwo PY, Lightdale JR, Nuccio S, Rex DK, Schiller LR. Multisociety sedation curriculum for gastrointestinal endoscopy. Gastroenterology. 2012 Jul;143(1):e18-41. Abstract Full text (link to original source) Full text (in our servers)
  17. Gizzo S, Di Gangi S, Saccardi C, Patrelli TS, Paccagnella G, Sansone L, Barbara F, D'Antona D, Nardelli GB. Epidural analgesia during labor: impact on delivery outcome, neonatal well-being, and early breastfeeding. Breastfeed Med. 2012 Aug;7:262-8. Abstract
  18. ASGE Standard of Practice Committee., Shergill AK, Ben-Menachem T, Chandrasekhara V, Chathadi K, Decker GA, Evans JA, Early DS, Fanelli RD, Fisher DA, Foley KQ, Fukami N, Hwang JH, Jain R, Jue TL, Khan KM, Lightdale J, Pasha SF, Sharaf RN, Dominitz JA, Cash BD. Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc. 2012 Jul;76(1):18-24. Abstract Full text (link to original source) Full text (in our servers)
  19. Reynolds F. Labour analgesia and the baby: good news is no news. Int J Obstet Anesth. 2011 Abstract
  20. Wieczorek PM, Guest S, Balki M, Shah V, Carvalho JC. Breastfeeding success rate after vaginal delivery can be high despite the use of epidural fentanyl: an observational cohort study. Int J Obstet Anesth. 2010 Jul;19(3):273-7. Abstract
  21. Wilson MJ, MacArthur C, Cooper GM, Bick D, Moore PA, Shennan A; COMET Study Group UK. Epidural analgesia and breastfeeding: a randomised controlled trial of epidural techniques with and without fentanyl and a non-epidural comparison group. Anaesthesia. 2010 Abstract Full text (link to original source) Full text (in our servers)
  22. Cohen RS. Fentanyl transdermal analgesia during pregnancy and lactation. J Hum Lact. 2009 Abstract
  23. Goma HM, Said RN, El-Ela AM. Study of the newborn feeding behaviors and fentanyl concentration in colostrum after an analgesic dose of epidural and intravenous fentanyl in cesarean section. Saudi Med J. 2008 May;29(5):678-82. Abstract
  24. Camann W. Labor analgesia and breast feeding: avoid parenteral narcotics and provide lactation support. Int J Obstet Anesth. 2007 Abstract
  25. Mahadevan U, Kane S. American gastroenterological association institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006 Jul;131(1):283-311. Review. Abstract Full text (link to original source) Full text (in our servers)
  26. 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)
  27. Torvaldsen S, Roberts CL, Simpson JM, Thompson JF, Ellwood DA. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. Int Breastfeed J. 2006 Abstract Full text (link to original source) Full text (in our servers)
  28. Nitsun M, Szokol JW, Saleh HJ, Murphy GS, Vender JS, Luong L, Raikoff K, Avram MJ. Pharmacokinetics of midazolam, propofol, and fentanyl transfer to human breast milk. Clin Pharmacol Ther. 2006 Abstract
  29. Jordan S, Emery S, Bradshaw C, Watkins A, Friswell W. The impact of intrapartum analgesia on infant feeding. BJOG. 2005 Abstract Full text (link to original source) Full text (in our servers)
  30. Beilin Y, Bodian CA, Weiser J, Hossain S, Arnold I, Feierman DE, Martin G, Holzman I. Effect of labor epidural analgesia with and without fentanyl on infant breast-feeding: a prospective, randomized, double-blind study. Anesthesiology. 2005 Abstract
  31. Halpern SH, Ioscovich A. Epidural analgesia and breast-feeding. Anesthesiology. 2005 Abstract
  32. Chang ZM, Heaman MI. Epidural analgesia during labor and delivery: effects on the initiation and continuation of effective breastfeeding. J Hum Lact. 2005 Abstract
  33. Wang BP, Li QL, Hu YF. [Impact of epidural anesthesia during delivery on breast feeding]. Di Yi Jun Yi Da Xue Xue Bao. 2005 Abstract Full text (link to original source) Full text (in our servers)
  34. Nice FJ, De Eugenio D, Dimino TA, Freeny IC, Rovnack MB, Gromelski JS. Medications and Breast-Feeding: A Guide for Pharmacists, Pharmacy Technicians, and Other Healthcare Professionals. Part I. J Pharm Technol 2004;20:17-27. doi: 10.1177/875512250402000106.
  35. Radzyminski S. The effect of ultra low dose epidural analgesia on newborn breastfeeding behaviors. J Obstet Gynecol Neonatal Nurs. 2003 Abstract
  36. 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)
  37. 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)
  38. Steer PL, Biddle CJ, Marley WS, Lantz RK, Sulik PL. Concentration of fentanyl in colostrum after an analgesic dose. Can J Anaesth. 1992 Abstract Full text (in our servers)
  39. Leuschen MP, Wolf LJ, Rayburn WF. Fentanyl excretion in breast milk. Clin Pharm. 1990 Abstract
  40. Frecska E, Arato M, Banki CM, Mohari K, Perenyi A, Bagdy G, Fekete MI. Prolactin response to fentanyl in depression. Biol Psychiatry. 1989 Abstract
  41. Madej TH, Strunin L. Comparison of epidural fentanyl with sufentanil. Analgesia and side effects after a single bolus dose during elective caesarean section. Anaesthesia. 1987 Abstract

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