Last update Aug. 8, 2022

Morphine

Low Risk

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

It is an opioid agonist used for the relief of moderate to severe acute and chronic pain. It is the main alkaloid of opium, which is obtained from whole opium poppies (Papaver somniferum). Oral, epidural, subcutaneous, intramuscular, or intravenous administration

It is excreted in breast milk in small to moderate amounts (Baka 2002, Robieux 1990, Wittels 1990, Feilberg 1989), which could be clinically significant. When administered epidurally, excretion in milk is negligible. (Oberlander 2000, Zakowski 1993, Feilberg 1989)

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. (Reece 2017, Worthington 2013)

Low to moderate levels of drug has been found in the plasma of infants from treated mothers (Robieux 1990, Naumburg 1987) and harmful effects in the infants were not reported. (Worthington 2013, Hendrickson 2012, Robieux 1990)

There are fewer breastfeeding dropouts, lower milk levels, and fewer side effects in infants of mothers treated with morphine than with pethidine. (Yost 2004, Wittels 1997)

Analgesia used during the birth process is related to a brief delayed of stage II of Lactogenesis (milk come-in) (Lind 2014). No difference in breastfeeding rates at 6 weeks has been found in mothers who received subcutaneous morphine, epidural fentanyl, or nothing during labor and delivery (Mahomed 2019). No differences were found in the frequency of breastfeeding in the first hour in mothers who received epidural morphine or fentanyl or no epidural analgesia during labor and delivery (Fan 2020)Ketorolac, ibuprofen, and paracetamol for post-cesarean section analgesia improve breastfeeding initiation rates compared to morphine analgesia. (Macias 2022)

Morphine can increase Prolactin levels (Moshtaghi 2005, Zis 1984, Tolis 1975) and may decrease Oxytocin levels (Lindow1999), 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 (WHO 2002). 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)

Some authorities consider Morphine as the elective opioid medication for breastfeeding mothers (Lamvu 2018, Reece 2017, Worthington 2013, Rowe 2013, Sachs 2013, Howie 2006, Bar-Oz 2003, Spigset 2000, Ravin 1995). Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs: compatible with Breastfeeding in occasional doses. (WHO 2002). American Academy of Pediatrics: medication usually compatible with breastfeeding.(AAP 2001)

Alternatives

  • Fentanyl ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Ibuprofen ( 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

Morphine in other languages or writings:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 25 %
Molecular weight 285 daltons
Protein Binding 35 %
VD 3.6 - 5.3 l/Kg
pKa 8.1 -
Tmax 0.5 - 1 hours
1.5 - 3 hours
M/P ratio 2.45 -
Theoretical Dose iv.im: 0.015-0.075; epid: 0.01 mg/Kg/d
Relative Dose iv. im: 30; epid: 9 %
Ped.Relat.Dose 1 - 7.5 %

References

  1. Macias DA, Adhikari EH, Eddins M, Nelson DB, McIntire DD, Duryea EL. A comparison of acute pain management strategies after cesarean delivery. Am J Obstet Gynecol. 2022 Mar;226(3):407.e1-407.e7. Consulted on Aug. 8, 2022 Abstract Full text (link to original source)
  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. UNICEF UK. Caring for your baby at night. A guide for parents. 2018 Full text (link to original source) Full text (in our servers)
  5. 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
  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. 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)
  8. Dalal PG, Bosak J, Berlin C. Safety of the breast-feeding infant after maternal anesthesia. Paediatr Anaesth. 2014 Abstract
  9. 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)
  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. 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)
  12. 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 Sep;40(5 Suppl 3):S1-S80. Review. Abstract Full text (in our servers)
  13. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  14. 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)
  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. 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)
  17. 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)
  18. 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)
  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. UNICEF UK. Compartiendo la cama con tu bebé. Guía para madres que amamantan. Folleto 2006 Full text (in our servers)
  21. Moshtaghi-Kashanian GR, Esmaeeli F, Dabiri S. Enhanced prolactin levels in opium smokers. Addict Biol. 2005 Abstract
  22. 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
  23. 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.
  24. 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
  25. 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)
  26. Baka NE, Bayoumeu F, Boutroy MJ, Laxenaire MC. Colostrum morphine concentrations during postcesarean intravenous patient-controlled analgesia. Anesth Analg. 2002 Abstract
  27. 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)
  28. Spigset O, Hägg S. Analgesics and breast-feeding: safety considerations. Paediatr Drugs. 2000 Abstract
  29. 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)
  30. 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
  31. 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
  32. 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
  33. Ravin DS. Narcotic analgesics and breastfeeding. J Hum Lact. 1995 Abstract
  34. 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)
  35. Zakowski MI, Ramanathan S, Turndorf H. A two-dose epidural morphine regimen in cesarean section patients: pharmacokinetic profile. Acta Anaesthesiol Scand. 1993 Abstract
  36. 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
  37. Wittels B, Scott DT, Sinatra RS. Exogenous opioids in human breast milk and acute neonatal neurobehavior: a preliminary study. Anesthesiology. 1990 Abstract
  38. Feilberg VL, Rosenborg D, Broen Christensen C, Mogensen JV. Excretion of morphine in human breast milk. Acta Anaesthesiol Scand. 1989 Abstract
  39. Naumburg EG, Meny RG, Findlay J, Brill JL, Alger LS Codeine and morphine levels in breast milk and neonatal plasma. Pediatr Res. 1987;21(4, Pt 2):240A. Abstract 400 Full text (link to original source)
  40. Zis AP, Haskett RF, Albala AA, Carroll BJ. Morphine inhibits cortisol and stimulates prolactin secretion in man. Psychoneuroendocrinology. 1984 Abstract
  41. 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

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