Monday, September 21, 2015

Analgesia in Breastfeeding

Agent
·         Recommendation
·         Monitoring
Non Opiod Analgesics (preffered)
Paracetamol
·         Good Choice
·         Amounts in milk are much less than doses usually given to infants
·         Generally ADRs are rare
·         Case report of maculopapular rash
·         Safe and effective for analgesia in postpartum mothers
Ibuprofen
·         Preferred choice
·         extremely low levels in breastmilk, short half-life and safe use in infants
·         no adverse effects reported
·         safe and effective for analgesia in postpartum mothers
Diclofenac
·         consider diclofenac to be acceptable during breastfeeding
·         Other agents may be preferred
·         Data are limited 
·         Case report of Urticaria
Indomethacin
·         Acceptable/ other agents preffered
·         low levels of in breastmilk
·        No adverse events
·        Should be avoided if possible as there is one report of convulsions in a neonate exposed to this drug through breastmilk
Celecoxib
·         amount of celecoxib passing through breastmilk is too small to be harmful
·        must be balanced with higher cost and possible cardiovascular risks, which should be minimal with short-term use in healthy young women
Opioid Analgesics
Tramadol
·         excretion of tramadol into milk is low 
·         unlikely to adversely affect nursing infant
·         monitor infants for increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties or limpness, and contact a physician immediately if any of these occu
Morphine
·         considered an ideal due to its limited transport to milk and its poor oral bioavailability
·         Epidural morphine – small amounts of morphine in milk.
·         IV or oral - higher milk levels than with epidural morphine.
·         Newborn infants seem to be particularly sensitive even to small doses
·         Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of morphine to a few days at a low dosage
·         close infant monitoring- increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness,
Fentanyl
·         amounts of fentanyl ingested by the neonate are small in epidural and IV
·         No waiting period or discarding of milk is required 
References:
 1.                  www.drugs.com
2.                  Analgesia and anesthesia for the breastfeeding mother, revised 2012.
3.                  http://www.australianprescriber.com/magazine/34/1/8/10
4.                  Analgesics (Pain killers) and Breastfeeding. The Breastfeeding Network

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