Safety of codeine during breastfeeding: fatal morphine poisoning in the breastfed neonate of a mother prescribed codeine.
Recently a newborn died from morphine poisoning when his mother used codeine while breastfeeding. Many patients receive codeine for postlabour pain. Is it safe to prescribe codeine for nursing mothers?



When a mother is an ultrarapid metabolizer of cytochrome P450 2D6, she produces much more morphine when taking codeine than most people do. In this situation, newborns might be exposed to toxic levels of morphine when breastfeeding. Options to reduce this risk include discontinuing codeine after 2 to 3 days of use and being aware of symptoms of potential opioid toxicity in both mothers and newborns.
Madadi
Parvaz
P
Koren
Gideon
G
Cairns
James
J
Chitayat
David
D
Gaedigk
Andrea
A
Leeder
J Steven
JS
Teitelbaum
Ronni
R
Karaskov
Tatyana
T
Aleksa
Katarina
K
D000082:Acetaminophen / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000378:metabolism; D001942:Breast Feeding / Q000009:adverse effects*; D003061:Codeine / Q000009:adverse effects* / Q000378:metabolism; D019389:Cytochrome P-450 CYP2D6 / Q000235:genetics / Q000378:metabolism; D017809:Fatal Outcome; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008895:Milk, Human / Q000737:chemistry; D009020:Morphine / Q000032:analysis / Q000378:metabolism / Q000633:toxicity*; D009293:Opioid-Related Disorders / Q000150:complications / Q000235:genetics* / Q000378:metabolism
D000701:Analgesics, Opioid; D000082:Acetaminophen; D009020:Morphine; D019389:Cytochrome P-450 CYP2D6; D003061:Codeine