Is Dihydrocodeine safe while breastfeeding?
Here is what LactMed, the Drugs and Lactation Database published by the U.S. National Institute of Child Health and Human Development (NICHD), reports about Dihydrocodeine. The text below is quoted from that source — it is not our own verdict.
Summary of use during breastfeeding
Dihydrocodeine products are no longer marketed in the United States. Maternal use of oral opioids during breastfeeding can cause infant drowsiness, which may progress to rare but severe central nervous system depression. Like codeine, pharmacogenetics probably plays a role in the extent of central nervous system depression with dihydrocodeine. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Dihydrocodeine possibly caused severe respiratory depression in one newborn infant whose mother was taking the drug for cough. If dihydrocodeine is required by the mother of a newborn, it is not a reason to discontinue breastfeeding; however, once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of dihydrocodeine to 2 to 3 days at a low dosage with close infant monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. Withdrawal symptoms can occur in breastfed infants when maternal administration of an opioid analgesic is stopped, or when breastfeeding is stopped. Because there is little published experience with dihydrocodeine during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
Effects on the breastfed infant
A woman began taking dihydrocodeine drops for cough twice daily (5.28 mg) beginning on the first day postpartum. One day later, her breastfed infant was difficult to arouse and was not breastfeeding well. The infant had bradycardia, hypoglycemia, and an oxygen saturation of 85%. After 24 hours in the hospital, all symptoms resolved. The symptoms were possibly caused by dihydrocodeine in milk.[2]
Effects on milk supply
Narcotics can increase serum prolactin.[3] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.
Levels in milk
Dihydrocodeine is metabolized via CYP2D6 to the active metabolite, dihydromorphine, which has a potency similar to morphine. Other weakly active metabolites include nordihydrocodeine, which is formed via CYP3A4, and dihydrocodeine-6-glucuronide. Both dihydrocodeine and dihydrocodeine-6-glucuronide are excreted renally.[1]
Maternal Levels. Relevant published information was not found as of the revision date.
Infant Levels. Relevant published information was not found as of the revision date.
Alternatives LactMed lists
Dihydrocodeine in pregnancy
LactMed covers breastfeeding only. For what the NHS and the US prescribing label say about pregnancy, see:
Source: Drugs and Lactation Database (LactMed), National Institute of Child Health and Human Development (NICHD), via NCBI Bookshelf, record “Dihydrocodeine” (LM1123). LactMed on NCBI Bookshelf. LactMed is a registered trademark of the U.S. Department of Health and Human Services.
Educational summary of an authoritative source — not medical advice. Never start, stop, or change a medicine while breastfeeding without confirming with your doctor.