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Dihydrocodeine and breastfeeding

I keep being asked about strong analgesics in breastfeeding. Lots of people seem unaware that codeine and dihydrocodeine sound similar but do not have the same risk in breastfeeding. Although many babies dont exhibit drowsiness when exposed to codeine during breastfeeding, dihydrocodeine is preferred.

This explains why:

The analgesic effect of dihydrocodeine appears to be mainly due to the parent compound. The oral bio availability of dihydrocodeine is 20% due to substantial first pass metabolism. The half life is quoted as 3.5-5h . It is metabolised in the liver by CYP2D6 to dihydromorphine, which has potent analgesic activity. However, the CYP2D6 pathway only represents a minor route of metabolism, with other metabolic pathways being involved.

The metabolism of dihydrocodeine is not affected by individual metabolic capacity as the analgesic effect is produced by the parent drug compared to codeine which is a pro drug.

Dihydrocodeine may be the preferred weak opioid for postoperative use in the breastfeeding woman, because of its cleaner metabolism compared with codeine and wide experience of use after caesarean section

Carbimazole in women of childbearing age

As for the valproate fact sheet this information on carbimazole taken for over active thyroid is included so that women who may become pregnant are aware of potential risks . https://www.gov.uk/drug-safety-update/carbimazole-increased-risk-of-congenital-malformations-strengthened-advice-on-contraception

This factsheet gives further information

carbimazole and pregnancy

Valproate and pregnancy

I know that this page is about breastfeeding and medication but I think that is important to share this too. I started writing it for another organisation a year ago but it hasnt gone anywhere so now it is here.

Anyone who is on sodium valproate (Epilim) should be taking adequate contraceptive protection https://www.fsrh.org/news/mhra-contraception-drugs-birth-defects-fsrh-guidance/ . It could be for epilepsy or it could be as a mood stabiliser but it is essential that you do not become pregnant. This factsheet explains why

valproate in pregnancy

Caffeine and Breastfeeding

Several questions have come up recently about caffeine intake and breastfeeding. With spending more time indoors we are probably all drinking more caffeinated beverages.

Most of us drink caffeine in one form or another. Women who drink a significant amount of caffeinated drinks who notice that their babies are jittery and restless, may find reduction in caffeine consumption leads to resolution of symptoms. This does not mean that all breastfeeding women need to restrict their consumption of tea and coffee A baby who appears restless may benefit from lowered caffeine intake by the mother but for the average consumption there is little evidence to support restricting intake. From research maternal consumption below 300 milligrammes a day should not cause issues for breastfed babies.

Extract reproduced from Breastfeeding and Medication 2018 by Jones W (Routledge, London)