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Pain relief when breastfeeding

By Wendy Jones in Fact Sheet, GP information, training on 10 April 2024.

It is not acceptable to leave any mother in pain because she is breastfeeding nor to suggest that she could have more effective pain relief if she stopped breastfeeding.

I’m often asked about the safety of opioids during breastfeeding so this is a really interesting study

Despite opioids being used first line in emergency settings to treat severe acute extremity pain, there is limited evidence available to inform this practice.

In a study in JAMA (7 November 2017), researchers randomly assigned 416 patients in the emergency department with moderate-to-severe acute extremity pain to one of the following groups: 400mg ibuprofen/1000mg paracetamol; 5mg oxycodone/325mg paracetamol; 5mg hydrocodone/300mg paracetamol; or 30mg codeine/300mg paracetamol[1].

https://jamanetwork.com/journals/jama/article-abstract/2661581?redirect=true

I have written this powerpoint presentation which I hope explains the analgesic ladder and helps professionals to understand the compatibility of analgesics and breastfeeding

Paracetamol or NSAID
Paracetamol + NSAID
Paracetamol+NSAID+Opioid (at the lowest possible dose for the shortest possible time co prescribed with a laxative)

Non steroidal anti inflammatory drugs

Compatible with breastfeeding: ibuprofen, diclofenac (Voltarol ™, Difene™), naproxen (Naprosyn™) https://breastfeeding-and-medication.co.uk/fact-sheet/naproxen-and-breastfeeding
No data on compatibility with breastfeeding: etoricoxin (Arcoxia™), meloxicam (Mobic™)
See https://www.sps.nhs.uk/articles/using-nsaids-during-breastfeeding

Opioids

compatible with breastfeeding: oral morphine, dihydrocodeine
https://breastfeeding-and-medication.co.uk/fact-sheet/dihydrocodeine-and-breastfeeding
use with caution as may cause drowsiness: oxycodone (Oxycontin™, Oxyfast™)
avoid if possible as may cause drowsiness: codeine

https://breastfeeding-and-medication.co.uk/thoughts/breastfeeding-and-codeine

https://breastfeeding-and-medication.co.uk/fact-sheet/accidental-dose-of-codeine-when-breastfeeding

All opioids can cause nausea and dizziness but almost invariably cause constipation so it is wise to commence stool softeners like lactulose and/or docusate both of which are compatible with breastfeeding as they don’t pass into milk.

See

https://breastfeeding-and-medication.co.uk/fact-sheet/constipation-laxatives-and-breastfeeding

Analgesics and breastfeeding Powerpoint