Is Propoxyphene Safe in Breastfeeding

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

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Maternal use of oral narcotics during breastfeeding can cause infant drowsiness, central nervous system depression and even death. Newborn infants seem to be particularly sensitive to the effects of even small dosages of propoxyphene may be particularly prone to causing these effects. Propoxyphene should be avoided during breastfeeding.[1]

In a case-control study of 12 breastfed term newborns with unexplained episodes of apnea, bradycardia or cyanosis during the first week of life, maternal oral propoxyphene use was determined to be the probable cause. A higher proportion of newborns with episodes, 83 compared to 31%, had mothers using opiates, including propoxyphene, for postpartum analgesia. The mean number of doses taken was also higher with mothers of affected newborns taking a mean of 10 doses (range 4 to 22) compared to 5 doses (range 1 to 13) in the control group.[4] A fullterm breastfed infant had mild hypotonia and nursing poorly at 10 days of age; the infant had not regained her birth weight by this time. By 7 days later, the mother had less milk and stopped nursing. The infant's mother had been prescribed 6 capsules daily of propoxyphene 30 mg plus acetaminophen 500 mg for the first 10 days postpartum. Hair samples from the infant were positive for propoxyphene and norpropoxyphene and were higher than the mother's hair sample concentrations.[5] Propoxyphene was probably the cause of the adverse reactions in the infant. All adverse reactions in breastfed infants reported in France between January 1985 and June 2011 were compiled by a French pharmacovigilance center. Of 174 reports, propoxyphene was reported to cause adverse reactions in 11 infants and to be one of the drugs most often suspected in serious adverse reactions. Reactions included hypotonia, apnea, respiratory distress, bradycardia, constipation and weight loss.[6]

Narcotics can increase serum prolactin.[7] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.