Last update Aug. 9, 2022

Hydromorphone Hydrochloride

Low Risk

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

Hydromorphone is a potent (7-10 times more powerful than morphine) semi-synthetic narcotic analgesic used for the relief of moderate to severe pain. It is one of the metabolites of hydrocodone. Oral, intranasal, rectal, subcutaneous, intramuscular or intravenous administration.

It is excreted in breast milk in very small amounts. (Sauberan 2011, Edwards 2003)

A 6-day-old infant whose mother was taking hydromorphone had respiratory depression that was reversible with naloxone. (Schultz 2019)

El uso intravenoso de opioides durante la cirugía se considera seguro para reanudar la lactancia una vez la madre esté despierta y en condiciones. (Reece 2017)

A restricted use of hydromorphone should be made in lactating mothers (Lamvu 2018, Sachs 2013). Until more published data is known about this drug in relation to breastfeeding, known safer alternatives are preferable (Lamvu 2018, Rowe 2013), especially during the neonatal period and in the event of prematurity.

After intravenous use of opioids during surgery, it is considered safe to resume breastfeeding once the mother is awake and fit. (Reece 2017)

Alternatives

  • Buprenorphine Hydrochloride ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Butorphanol Tartrate ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Ibuprofen ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Morphine (Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.)
  • Nalbuphine Hydrochloride ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Paracetamol ( Safe. Compatible. Minimal risk for breastfeeding and infant.)

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

Hydromorphone Hydrochloride in other languages or writings:

Group

Hydromorphone Hydrochloride belongs to this group or family:

Tradenames

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

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 50 - 60 %
Molecular weight 322 daltons
Protein Binding 8 - 19 %
VD 4 l/Kg
pKa 10.1 -
Tmax 0.5 - 1 / prol: 9 hours
2 - 3 / prol: 8 - 15 hours
M/P ratio 3 -
Relative Dose 0.7 %

References

  1. Patricelli CJ, Gouin IJ, Gordon S, Carter N, Albert A, Paquette V, Stewart K, George S, Urbanoski K. Breastfeeding on Injectable Opioid Agonist Therapy: A Case Report. J Addict Med. 2023 Mar-Apr 01;17(2):222-226. Abstract Full text (link to original source)
  2. Schultz ML, Kostic M, Kharasch S. A Case of Toxic Breast-feeding? Pediatr Emerg Care. 2019 Jan;35(1):e9-e10. Abstract
  3. Lamvu G, Feranec J, Blanton E. Perioperative pain management: an update for obstetrician-gynecologists. Am J Obstet Gynecol. 2018 Feb;218(2):193-199. Abstract
  4. 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)
  5. Dalal PG, Bosak J, Berlin C. Safety of the breast-feeding infant after maternal anesthesia. Paediatr Anaesth. 2014 Abstract
  6. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  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. Sauberan JB, Anderson PO, Lane JR, Rafie S, Nguyen N, Rossi SS, Stellwagen LM. Breast milk hydrocodone and hydromorphone levels in mothers using hydrocodone for postpartum pain. Obstet Gynecol. 2011 Abstract
  9. Edwards JE, Rudy AC, Wermeling DP, Desai N, McNamara PJ. Hydromorphone transfer into breast milk after intranasal administration. Pharmacotherapy. 2003 Feb;23(2):153-8. Abstract

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