Is Butorphanol Safe in Breastfeeding

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

Avoid a chronic usage.

Limited data indicate that butorphanol is excreted into breastmilk in small amounts. Butorphanol is poorly orally absorbed, so it is unlikely to adversely affect the breastfed infant. However, because there is no published experience with repeated, high, intravenous or intranasal doses of butorphanol during breastfeeding, other agents may be preferred in these situations, especially while nursing a newborn or preterm infant. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants. As with other narcotics, once the mother's milk comes in, it is best to limit maternal intake and to supplement analgesia with a nonnarcotic analgesic if necessary for pain control. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. Labor pain medication may delay the onset of lactation.

Narcotics and narcotic agonist-antagonists can increase serum prolactin.[2][3] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed. A study compared women who received butorphanol or nalbuphine during labor (n = 26) to those who received no analgesia (n = 22). The time to effective breastfeeding was longer (46.5 minutes) in the analgesia group than in the no analgesia group (35.4 minutes).[4] A national survey of women and their infants from late pregnancy through 12 months postpartum compared the time of lactogenesis II in mothers who did and did not receive pain medication during labor. Categories of medication were spinal or epidural only, spinal or epidural plus another medication, and other pain medication only. Women who received medications from any of the categories had about twice the risk of having delayed lactogenesis II (>72 hours) compared to women who received no labor pain medication.[5]