Is Dihidrocodeina [INN-Spanish] Safe in Breastfeeding

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

Used for pain and cough relief. As analgesic it is not more effective than Ibuprofen. The enzyme cytochrome P450-CYP2D6 catalyzes its metabolization into dehydromorphine. On date of latest update relevant data concerning breastfeeding were not found. Product with similar characteristics than Codeine but with lower oral bioavailability which would be advantageous for breastfed infants. Codeine is excreted into breast milk in non-significant amount, however, serious health problems have appeared among off-spring of mothers who are rapid metabolizers from Codeine to Morphine. Discontinue if excessive sedation appears in mother or infant, and, do not administer if such a background in mother or family is present, as there are between 1% and 29% of people who are rapid metabolizers from codeine to morphine with an excess of the gene linked to enzyme P450-CYP2D6.

Maternal use of oral narcotics during breastfeeding can cause infant drowsiness, central nervous system (CNS) depression and even death. Like codeine, pharmacogenetics probably plays a role in the extent of CNS depression. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Dihidrocodeina [INN-Spanish] possibly caused severe respiratory depression in one newborn infant whose mother was taking the drug for cough. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of hydromorphone to a few days at a low dosage with close infant monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. Because there is little published experience with dihydrocodine during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.

A woman began taking Dihidrocodeina [INN-Spanish] drops for cough twice daily (5.28 mg) beginning on the first day postpartum. One day later, her breastfed infant was difficult to arouse and was not breastfeeding well. The infant had bradycardia, hypoglycemia, and an oxygen saturation of 85%. After 24 hours in the hospital, all symptoms resolved. The symptoms were possible caused by Dihidrocodeina [INN-Spanish] in milk.[2]

Narcotics can increase serum prolactin.[3] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.