Question

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

Tramadol lactation summary

Tramadol is safe in breastfeeding
  • DrLact safety Score for Tramadol is 1 out of 8 which is considered Safe as per our analyses.
  • A safety Score of 1 indicates that usage of Tramadol is mostly safe during lactation for breastfed baby.
  • Our study of different scientific research also indicates that Tramadol does not cause any serious side effects in breastfeeding mothers.
  • Most of scientific studies and research papers declaring usage of Tramadol safe in breastfeeding are based on normal dosage and may not hold true for higher 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.

Answer by Dr. Ru: About Tramadol usage in lactation

Excretion into breast milk is non-significant. No harmful effects on breastfed infants from treated mothers have occurred. Because it is an opium-related medication, a minimal effective dose should be used together with a close follow-up of child's sedation and feeding difficulties.

Answer by DrLact: About Tramadol usage in lactation

The excretion of tramadol into milk is low and even lower amounts of the active metabolite, O-desmethyltramadol, are excreted. With usual maternal dosage, the amount excreted into breastmilk is much less than the dose that has been given to newborn infants for analgesia. A study of breastfeeding in breastfed newborn infants found no adverse effects attributable to tramadol. Although tramadol is unlikely to adversely affect nursing infant,[1] the U.S. Food and Drug Administration recommends against the use of tramadol during breastfeeding.[2] If tramadol is used, monitor infants for increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties or limpness, and contact a physician immediately if any of these occur.

Tramadol Side Effects in Breastfeeding

Seventy-five breastfed infants whose mothers were breastfeeding and taking tramadol 100 mg every 6 hours following a cesarean section were compared to 75 matched infants at 2 to 4 days of age. Forty-nine percent of the mothers taking tramadol and all of the control mothers were taking other opiates (primarily oxycodone) and 61% of and 58%, respectively, also were taking a nonsteroidal antiinflammatory agent (primarily diclofenac). Examination by a pediatrician revealed no difference between the groups using the Neurologic and Adaptive Capacity Score.[5]

Tramadol Possible Effects in Breastfeeding

Tramadol can increase serum prolactin.[8] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed. A randomized study compared tramadol and naproxen for post-cesarean section pain. Patients received the drugs either on a fixed schedule or as needed. No difference in breastfeeding rates were seen among the groups.[9] In a study in China, women with a scheduled cesarean section were randomized to receive intravenous patient-controlled analgesia with either sufentanil or tramadol. Postpartum prolactin levels were higher in the tramadol group (348 mcg/L) than in the sufentanil group (314 mcg/L). The onset of lactation was sooner in the tramadol group (21.4 hours) than in the sufentanil group (25.1 hours). Both of these difference were statistically significant.[10] Note that injectable tramadol is not available in the United States.

Alternate Drugs

Fentanyl(Safe)
Pentazocine(Low Risk)
Oxycodone(Unsafe)
Butorphanol(Low Risk)
Heroin(Dangerous)
Morphine(Low Risk)
Tramadol(Safe)
Methadone(Safe)
Meperidine(Low Risk)
Sufentanil(Low Risk)
Remifentanil(Low Risk)
Hydrocodone(Low Risk)
Fentanyl(Safe)
Pentazocine(Low Risk)
Codeine(Unsafe)
Oxycodone(Unsafe)
Butorphanol(Low Risk)
Heroin(Dangerous)
Dihydrocodeine(Low Risk)
Morphine(Low Risk)
Tramadol(Safe)
Methadone(Safe)
Meperidine(Low Risk)
Sufentanil(Low Risk)
Remifentanil(Low Risk)
Hydrocodone(Low Risk)
Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. We do not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.