Risks of maternal codeine intake in breast-fed infants: A Joint Statement of Retraction from the Canadian Pharmacists Journal and Canadian Family Physician

Opioid analgesia for breastfeeding mothers

“…Practice changed dramatically, however, after one high profile case of an infant’s death in association with a codeine-paracetamol product in 2006, allegedly from over-expression of the enzyme P450 2D6 (CYP2D6) in the neonate, metabolising codeine ingested through breast milk to excess morphine 45. As codeine and paracetamol concentrations were unexpectedly high in the infant post mortem, reports of the case were eventually discredited and have now been retracted 67. But concern about opioids in breast milk persists among drug regulators 8…”

“…Occasional reports of drowsiness in breastfed infants associated with maternal codeine are still published, leaving mothers and their clinicians with important questions about the safety of opioid analgesia after childbirth 6. The linked paper by Zipursky and colleagues (doi:10.1136/bmj-2022-074005) provides important new data to inform treatment 9…”

“…Zipursky and colleagues’ new study shows that opioids do not present a unique hazard for infants of breastfeeding mothers. As the maternal dose of opioid (mg/kg) is 10 times higher than that of the infant, mothers were more likely to experience adverse effects from opioids than their infants 6. If they do, the infant may require increased clinical monitoring.…”