Oxycodone is an opioid analgesic (painkiller) prescribed when paracetamol and ibuprofen provide inadequate pain relief. Other opioid painkillers include codeine (not recommended in breastfeeding but see https://breastfeeding-and-medication.co.uk/fact-sheet/accidental-dose-of-codeine-when-breastfeeding ), dihydrocodeine ( see https://breastfeeding-and-medication.co.uk/fact-sheet/dihydrocodeine-and-breastfeeding) , tramadol and morphine  . ( https://breastfeeding-and-medication.co.uk/fact-sheet/pain-relief-when-breastfeeding). All of these drugs can cause constipation so should be prescribed with a suitable laxative ( https://breastfeeding-and-medication.co.uk/fact-sheet/constipation-laxatives-and-breastfeeding) .

Brand name: OxyContin, OxyNorm

Oxycodone is an opiate used for severe pain often post operatively. It is suggested that it is associated with more sedation than other opiates. Timm (2013) reported on a 4-day-old breastfed infant who was taken to the emergency department with symptoms indicating opioid intoxication resulting from his mother’s use of oxycodone after caesarean delivery. The infant was hypothermic, lethargic, and had pinpoint pupils. A dose of naloxone reversed the symptoms and the baby fed. The mother discontinued oxycodone and the baby was discharged without further pathology.

Seaton (2007) studied fifty breast-feeding mothers taking oxycodone following caesarean section. Blood and breast milk samples were analysed and forty-one neonates had blood samples taken at 48 hours. Oxycodone was detected in the milk of mothers who had taken any dose in the previous 24 hours. The authors concluded that Oxycodone is concentrated in human breast milk up to 72 hours after delivery and that infants may receive > 10% of a therapeutic infant dose. However, maternal oxycodone intake up to 72-h post section poses only minimal risk to the breast-feeding infant as low volumes of breast milk are ingested during this period.

Whilst it may be suitable as an analgesic short-term post operatively a breastfed infant should be monitored carefully for sedation and breathing difficulties. Studies appear to relate largely to use in the immediate post-partum period at a dose of 5-10mg as necessary to a maximum of 40mg in 24 hours. The dose should be as low as possible for as short a period as possible as with all opioid medication. and titrated down to paracetamol and NSAID once pain relief is adequate.

Hale reports a half-life of 2-4 hours so normally the drug would be assumed to have left the body after 20 hours. The milk plasma level exceeds 1 (3.4) but the oral bioavailability is 60-87% which explains the relative infant dose of 1.01% – 8%

Observe baby for sedation and poor feeding.

References

• Seaton S, Reeves M, McLean S. Oxycodone as a component of multimodal analgesia for lactating mothers after Caesarean section: Relationships between maternal plasma, breast milk and neonatal plasma levels. Aust N Z J Obstet Gynaecol. 2007;47:181-5.
• Timm NL. Maternal use of oxycodone resulting in opioid intoxication in her breastfed neonate. J Pediatr. 2013;162:421-2.
• Hale T, Krutsch K.  Hale’s Medications & Mothers’ Milk 2025-2026

Text taken from Breastfeeding and Medication 2nd ed 2017 Jones W (Routledge)