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Breastfeeding and Codeine

it seems that more people ask about the use of codeine than any other drug. The changes in guidance following the MHRA report in 2013 and 2015 seem to cause much confusion. We need to be aware as mothers that if we take codeine and our babies become sleepy (sleep longer or more frequently) then this is a sign that we may have the metabolism that concentrates the drug in breastmilk and should stop taking the drug. It takes 15 hours to be clear from the system but unless the baby shows signs of breathing difficulties it isnt a reason to panic . If there are breathing difficulties medical help should be sought urgently.

The oral bio availability of dihydrocodeine is 20% due to substantial first pass metabolism. The half life is quoted as 3.5-5h (Martindale). 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. Bisson DL, Newell SD, Laxton C, on behalf of the Royal College of Obstetricians and Gynaecologists. Antenatal and Postnatal Analgesia. Scientific Impact Paper No. 59. BJOG 2019;126:e115–24.

Codeine should only be used if paracetamol and ibuprofen/naproxen/diclofenac are providing insufficient pain relief or are contra indicated.

Dihydrocodeine has a cleaner metabolism and as such is preferred as the opiate painkiller (co-dydramol when combined with paracetamol) . This generally requires a prescription. In some areas codeine is still prescribed to breastfeeding mothers, in others it is totally forbidden. In this fact sheet I have tried to provide the full research history so that you can make an informed decision about what is right for you and your baby. We should also be alert to the fact that codeine is very addictive to us as adults so longterm use unless under medical supervision should be avoided