Is Percodan Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Percodan? Is Percodan safe for nursing mother and child? Does Percodan extracts into breast milk? Does Percodan has any long term or short term side effects on infants? Can Percodan influence milk supply or can Percodan decrease milk supply in lactating mothers?

• DrLact safety Score for Percodan is 5 out of 8 which is considered Unsafe as per our analyses.
• A safety Score of 5 indicates that usage of Percodan may cause serious side effects in breastfed baby.
• Our study of different scientific research indicates that Percodan may cause moderate to high side effects or may affect milk supply in lactating mother.
• Our suggestion is to use safer alternate options rather than using Percodan .
• It is recommended to evaluate the advantage of not breastfeeding while using Percodan Vs not using Percodan And continue breastfeeding.
• While using Percodan Its must to monitor child for possible reactions. It is also important to understand that side effects vary largely based on age of breastfed child and time of medication in addition to dosage.
• Score calculated using the DrLact safety Version 1.2 model, this score ranges from 0 to 8 and measures overall safety of drug in lactation. Scores are primarily calculated using publicly available case studies, research papers, other scientific journals and publically available data.

Very often used for treatment of pain associated to episiotomy or Cesarean section operation. Excreted and accumulates into breast milk in significant amount along with associated problems among 20% of breastfed infants from treated mothers. Side effects have been rarely severe like excessive sedation, letargia, hypothermia and apnea. Dose should not be higher than 30 mg a day for no longer than 3 days. Women with some variants of enzyme-linked gene CYP2D6 who are on Percodan and their breastfed infants may experience increased sedation. Dose should not be higher than 30 mg a day for no longer than 3 days. Use of Percodan during childhood is risky because of a large elimination half-life variability. Adequately use of nonsteroidal anti-inflammatory drugs (NSAIDs) may attain pain relief with less side effects than with narcotic analgesics.

Maternal use of oral narcotics during breastfeeding can cause infant drowsiness, central nervous system depression and even death. Infant sedation is common and well documented with maternal use of Percodan. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of oral Percodan (and combinations) to a 2 to 3 days, especially in the outpatient setting.[1] A maximum Percodan dosage of 30 mg daily is suggested, although some sources recommend avoiding Percodan during breastfeeding.[2][3] Percodan elimination is decreased in young infants with much inter-individual variability. Monitor the infant closely for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. Other agents are preferred over Percodan during breastfeeding.[2]

A 10-month-old, 7.7 kg infant of a prescription drug-dependant mother died of cardiac arrest after a 12- to 24-hour period of lethargy, hypersomnolence and dyspnea. The infant also had a recent history of fever. The mother had reportedly been breastfeeding the infant 3 times a day for several weeks and had taken 180 mg of Percodan, as well as muscle relaxants, the day prior to her infant's death. A blood Percodan level of 600 mcg/L was measured on autopsy. The medical examiner considered it unlikely that such a high level of Percodan in the infant's blood could be due to breastfeeding exposure as reported by the mother and thus considered the death a homicide resulting from either the intentional administration of Percodan directly to the infant or from a higher dose of Percodan in breastmilk than that reported by the mother.[9] In a study of 50 mothers taking Percodan post-cesarean section, 50 neonates were evaluated for sedation over 48 hours after birth. None was severely sedated and less than 4% had sedation of 3 on a 1 (fully alert) to 5 (difficult to rouse) scale and none more sedated than 3 on the scale. Because these infants were in the first 3 days postpartum, their Percodan dose was probably limited by the small volumes of colostrum they were ingesting.[7] An infant was born to a mother taking Percodan 20 mg 3 times daily, fluoxetine 40 mg daily and quetiapine 400 mg daily. The infant was breastfed 6 to 7 times daily and was receiving 120 mcg of oral morphine 3 times daily for opiate withdrawal. Upon examination at 3 months of age, the infant's weight was at the 25th percentile for age, having been at the 50th percentile at birth. The authors attributed the weight loss to opiate withdrawal. The infant's Denver developmental score was equal to his chronological age.[10] A woman who was exclusively breastfeeding her infant was taking 5 to 10 mg of Percodan every 4 to 6 hours for episiotomy pain. Her 45-day-old infant was brought to the emergency department with a temperature of 98.4 degrees F, a heart rate of 154 per minute, 20 breaths per minute, a blood pressure of 71/52, and an oxygen saturation of 60% to 69% on room air. The infant had been constipated since birth, passing one stool every 5 to 8 days. The infant had sluggish movements slow, shallow, and irregular breathing. Her pupils were small, but reactive. Hydromorphone levels in urine were elevated. The patient was intubated and given opiates around the clock for two days before being extubated and discharged. The infant's constipation, CNS and respiratory depression were probably caused by Percodan in breastmilk.[8] In a retrospective study, nursing mothers who were taking either Percodan, codeine or acetaminophen for pain while breastfeeding were contacted by telephone to ascertain the degree of maternally perceived central nervous system (CNS) depression. Mothers taking Percodan reported signs of CNS depression in 20% (28/139) of their infants, while those taking acetaminophen reported infant CNS depression in only 0.5% (1/184) of their infants. Women who reported infant sedation were taking 0.4 mg/kg daily of Percodan, and unaffected were taking 0.15 mg/kg daily. Affected infants had more hours of daily uninterrupted sleep than unaffected infants, and 4 of the affected infants reportedly had "irregular breathing". Thirty-eight of 39 mothers reported that infant sedation ceased with maternal Percodan discontinuation. Mothers of affected infants were also more likely to experience lethargy and other side effects than mothers of unaffected infants. Mothers who took codeine reported a similar rate of infant sedation (17%) compared to Percodan, but the groups were statistically different in parity and postmenstrual age (PMA), with the codeine group having a slightly higher PMA.[11] A newborn infant was exclusively breastfed and found to be well by his physician at 2 days of age. At 3 days postpartum, the infant began to be sedated and became difficult to arouse and did not feed from either breast. At 4 days of age, the infant was brought to the emergency department where the infant was found to have lethargy, hypothermia, pinpoint pupils, and a poor sucking reflex. The mother reported that her milk had come in the previous evening. She had taken 10 mg of Percodan that evening and another 5 mg the next morning in the form of Percocet (Percodan 5 mg plus acetaminophen 325 mg). The infant was given naloxone 0.34 mg intramuscularly and within 2 minutes, the baby's eyes opened and he drank 45 mL of formula. No further sedation was seen over the next 24 hours.[12] The infant's sedation was probably caused by Percodan in breastmilk.

Percodan can increase serum prolactin.[13] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.