Last update Aug. 15, 2022
Very Low Risk
It is an opioid analgesic used to treat moderate to severe pain, opioid dependence, and neonatal opioid withdrawal syndrome. Oral, intramuscular, intravenous and subcutaneous administration.
It is excreted in breast milk in clinically non-significant amount. (Bogen 2011, Nikolaou 2008, Jansson 2008 & 2007, Begg 2001, McCarthy 2000, Wojnar 1997, Geraghty 1997, Pond 1985, Kreek 1979 & 1974, Blinick 1975)
No problems in the short or long term have been observed in infants whose mothers were treated. (Malpas 1999, Wojnar 1997, Blinick 1975)
Plasma levels of these infants were undetectable or very low. (Jansson 2008 & 2008, Wojnar 1997)
Exposure of the newborn to methadone through breast milk is insufficient to prevent the development of a neonatal withdrawal syndrome (Wojnar 1997). The dose that gets the infant through the mother's milk, even when taking 70-150 mg a-day, is much lower than that used to treat neonatal abstinence syndrome. This is a reason for not using it as a solely measure of treatment.
Neonatal methadone withdrawal syndrome is less common, less severe, with less need for pharmacological treatment, and occurs later in breastfed infants than in non-breastfed infants (McQueen 2019, Wachman 2017, Short 2016, Liu 2015, Bagley 2014, Sutter 2014, Welle 2013, Pritham 2012, Hodgson 2012, McQueen 2011, Isemann 2011, Dryden 2009, Jansson 2008, Miles 2007, Abdel 2006, Arlettaz 2005, Malpas 1997). Neonatal abstinence syndrome can occur after abrupt weaning in infants of mothers on methadone maintenance. Weaning should be gradual to avoid its appearance. (Isemann 2011, Malpas 1999)
Methadone can cause galactorrhea due to increased prolactin secretion. (Bennett 2006, Tolis 1978)
The frequency and duration of breastfeeding are very low in opiate-dependent mothers. (Wachman 2010, Jansson 2004). Many newborns of mothers with drug addiction are either premature or underweight infants, and over 60% develop withdrawal syndrome at about one post-natal month. Breastfeeding with regard to the entire context of addictive behavior is neither easy nor frequently achieved. Much help is needed on supporting addicted mothers by health and social services in the community.
Expert authors consider the use of this medication compatible during breastfeeding (Hale, ACOG 2017, ABM 2015, Briggs 2015, Schaefer 2015, Kocherlakota 2014, Bagley 2014, Sachs 2013, Logan 2013, Rowe 2013, D'Apolito 2013, Nice 2004, Moretti 2000). American Academy of Pediatrics: medication usually compatible with breastfeeding.(AAP 2001)
It should be reinforced that it is observed a non-polydrug behavior and adequacy of maternal care is maintained.
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.
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Thank you for helping to protect and promote breastfeeding.
e-lactancia is a resource recommended by Asociación Española de Bancos de Leche Humana of Spain
Would you like to recommend the use of e-lactancia? Write to us at corporate mail of APILAM