Codeine and the Breastfed Neonate

Meny, Robert G.; Naumburg, Eric G.; Alger, Lindsay S.; Brill-Miller, Janice L.; Brown, Sarah E.

doi:10.1177/089033449300900423

Cited by 68 publications

(28 citation statements)

References 9 publications

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“…Codeine has a milk-to-plasma ratio of slightly more than 1 suggesting it is generally safe (Meny et al, 1993), but morphine toxicity and death has been reported in a breastfed neonate whose mother was an ultra-rapid metaboliser of codeine (Madadi et al, 2008 Level IV). A relationship between infant central nervous system (CNS) symptoms (decreased alertness, lethargy, poor…”

Section: Opioids and Tramadolmentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

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Section: Opioids and Tramadolmentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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“…However, there is no published data on analysis of heroin in human breast milk, while two publications reported on the determination of codeine and morphine levels by radioimmunoassay (RIA) [134] and the determination of morphine and its metabolite by LC-UV [135]. With respect to cannabis, Perez-Reyes & Wall quantified for the first time Δ9-tetrahydrocannabinol (THC) in two breastfeeding women [136] but no validation parameters were available.…”

Section: Analytical Methods For Determination Of Licit and Illicit Drugmentioning

confidence: 99%

Maternal and Neonatal Hair and Breast Milk in The Assessment of Perinatal Exposure to Drugs of Abuse

et al. 2015

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Perinatal exposure to one or more drugs of abuse can affect the neonate temporarily or permanently. In addition to meconium, the evaluation of perinatal exposure to drugs of abuse has been achieved by testing biological matrices coming from the newborn (neonatal hair) and from the pregnant or nursing mother (maternal hair and breast milk). These matrices have the advantage of noninvasive collection and account for a sizable time window of active and passive exposure. Sensitive and specific analytical methods are required to determine minute amounts of drugs of abuse and metabolites in these matrices. The present manuscript reviews the newest analytical methods developed to detect drugs of abuse as well as ethanol biomarkers in maternal and neonatal hair and breast milk.

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“…The FDA review3 and LactMed summary4 of the medical literature of data regarding codeine use during breast feeding found numerous cases of excess sedation and respiratory depression in breastfed infants. These reviews reference the early breast milk and newborn plasma assay article36 and have included the above-mentioned case report about a neonatal death (published twice2 37). The mother in the latter case had taken repeated doses of paracetamol combined with codeine for several days.…”

Section: Contraindications For Codeine Should Not Be Applied To Tramamentioning

confidence: 99%

Tramadol, breast feeding and safety in the newborn

et al. 2018

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Codeine and the Breastfed Neonate

Cited by 68 publications

References 9 publications

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Maternal and Neonatal Hair and Breast Milk in The Assessment of Perinatal Exposure to Drugs of Abuse

Tramadol, breast feeding and safety in the newborn

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