Last update Aug. 10, 2022

Oxycodone

Limited compatibility

Unsafe. Moderate/severe adverse effects. Compatible under certain circumstances. Follow-up recommended. Use safer alternative or discontinue breastfeeding from 5 to 7 T ½ . Read Commentary.

It is an opioid used in the management of moderate to severe pain. Its active metabolite, oxymorphone, is 14 times more potent than oxycodone (Dalal 2014). Very often used for treatment of pain associated to episiotomy or Cesarean section operation. Oral, subcutaneous or intravenous administration.

It is excreted in breast milk in a small amount, but it could be significant. (Seaton 2007, Marx 1986)

In a study with possible methodological biases (Rivers 2012), mild symptoms of central nervous system depression were observed in 20% of newborns breastfed by mothers taking oxycodone for postpartum analgesia (Lam 2012, Seaton 2007). Symptoms have occasionally been severe, with neurologic and respiratory depression, especially in the neonatal period (Beauchamp 2019, Timm 2013, Sulton 2012). No long-term problems have been seen in infants whose mothers were taking it. (Rampono 2007)

Dose should not be higher than 30 mg a day. (Lamvu 2018, Sachs 2013)

Women with some variants of enzyme-linked gene CYP2D6 who are on Oxycodone and their breastfed infants may experience increased sedation. (van den Anker 2012)

Overall, the use of opioids for pain control during labor and another 3 days is compatible with breastfeeding. The duration of opioid treatment should be limited to 3 days in unsupervised outpatient settings. (Ito 2018). Adequately use of nonsteroidal anti-inflammatory drugs (NSAIDs) may attain pain relief with less side effects than with narcotic analgesics.

Alternatives

  • Buprenorphine Hydrochloride (Safe substance and/or breastfeeding is the best option.)
  • Butorphanol Tartrate (Safe substance and/or breastfeeding is the best option.)
  • Ibuprofen (Safe substance and/or breastfeeding is the best option.)
  • Morphine (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
  • Nalbuphine Hydrochloride (Safe substance and/or breastfeeding is the best option.)
  • Paracetamol (Safe substance and/or breastfeeding is the best option.)

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

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Other names

Oxycodone is also known as


Oxycodone in other languages or writings:

Group

Oxycodone belongs to this group or family:

Tradenames

Main tradenames from several countries containing Oxycodone in its composition:

List of 27 tradenames

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 60 - 87 %
Molecular weight 315 daltons
Protein Binding 45 %
VD 2.6 l/Kg
Tmax 1 - 2 hours
T½ 3.5 - 6 / Metab: 9 hours
M/P ratio 3.4 -
Theoretical Dose 0.0087 - 0.0025 mg/Kg/d
Relative Dose 2.6 - 7.6 %

References

  1. 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
  2. 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
  3. Ito S. Opioids in Breast Milk: Pharmacokinetic Principles and Clinical Implications. J Clin Pharmacol. 2018 Oct;58 Suppl 10:S151-S163. 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. Timm NL. Maternal use of oxycodone resulting in opioid intoxication in her breastfed neonate. J Pediatr. 2013 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. Lam J, Kelly L, Matok I, Ross CJ, Carleton BC, Hayden MR, Madadi P, Koren G. Putative association of ABCB1 2677G>T/A with oxycodone-induced central nervous system depression in breastfeeding mothers. Ther Drug Monit. 2013 Abstract
  9. Lam J, Kelly L, Ciszkowski C, Landsmeer ML, Nauta M, Carleton BC, Hayden MR, Madadi P, Koren G. Central nervous system depression of neonates breastfed by mothers receiving oxycodone for postpartum analgesia. J Pediatr. 2012 Abstract Full text (link to original source) Full text (in our servers)
  10. van den Anker JN. Is it safe to use opioids for obstetric pain while breastfeeding? J Pediatr. 2012 Abstract Full text (in our servers)
  11. Rivers CM, Olsen D, Nelson LS. Breastfeeding and oxycodone. J Pediatr. 2012 Abstract Full text (link to original source) Full text (in our servers)
  12. Sulton-Villavasso C, Austin CA, Patra KP, Sankararaman S, Ray M, May R, Bordley C. Index of suspicion. Case 1: Infant who has respiratory distress. Case 2: Abnormal behavior, seizures, and altered sensorium in a 7-year-old boy. Case 3: Fever and dysphagia in a 4-year-old girl. Pediatr Rev. 2012 Abstract
  13. Amir LH, Pirotta MV, Raval M. Breastfeeding--evidence based guidelines for the use of medicines. Aust Fam Physician. 2011 Sep;40(9):684-90. Review. Abstract Full text (link to original source) Full text (in our servers)
  14. Seaton S, Reeves M, McLean S. Oxycodone as a component of multimodal analgesia for lactating mothers after Caesarean section: relationships between maternal plasma, breast milk and neonatal plasma levels. Aust N Z J Obstet Gynaecol. 2007 Abstract
  15. Rampono J, Kristensen JH, Ilett KF, Hackett LP, Kohan R. Quetiapine and breast feeding. Ann Pharmacother. 2007 Abstract
  16. Levine B, Moore KA, Aronica-Pollak P, Fowler DF. Oxycodone intoxication in an infant: accidental or intentional exposure? J Forensic Sci. 2004 Abstract
  17. Marx CM, Pucino F, Carlson JD, Driscoll JW, Ruddock V. Oxycodone excretion in human milk in the puerperium. Drug Intell Clin Pharm. 1986;20:474. Abstract.

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