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