Breastfeeding on Codeine

Are you nursing? Are you taking codeine? NPR reported on a recent FDA advisory to doctors and nursing mothers cautioning on the mother's use of codeine for the sake of nursing babies. If a mother is a "supermetabolizer," her body will break the drug down into its active form, morphine, too quickly. The morphine then floods the bloodstream, which "can cause drowsiness and interfere with breathing," potentially resulting in an overdose in the baby. It's rare though (1 reported death), and no other medications that include codeine (e.g., cold medication) have reportedly EVER caused any problems.

"If you're a nursing mother taking codeine, call your doctor if you're having difficulty taking care of your baby," Kweder says. "It could be a sign that you're metabolizing the drug more rapidly than most people."

It's the most widely prescribed postpartum medication, and the agency is NOT trying to eliminate its use. However, since 1-10% of people metabolize codeine rapidly, the article says there's reason to be cautious and watch for baby's reactions. There are genetic tests, but they're very expensive and not widely available. Mom's are better off getting the lowest dose of codeine for the shortest amount of time.

Overall, it sounds scary, but it's not a life-altering concern. Be cautious and observant with your baby. The article's suggestion to "call your doctor if you're having difficulty taking care of your baby" is a bit generic. What new parents get home and say "wow, this is much easier than I thought." Babies are difficult to take care of, full stop. But as with anything, if something doesn't seem right, call your doctor; that's what s/he's there for. And as your baby gets older, it becomes easier to see when behavior is out of character.

Generally, I try to take the least amount of medication needed (dose and duration) for my sake, and moreso now that I'm nursing. I take a daily vitamin. After a terrible bout of mastitis, I was taking lecithin for a while in hopes of keeping the ducts clear and flowing, though I stopped after a while with no ill effects. I've taken a bit of cold medicine during the worst part of my cold (twice since MetaBaby was born), though I try to keep that to a minimum because my doctor said antihistamines reduce a nursing woman's milk supply (true or not, why tempt fate?). The only other thing I take is Tylenol for my occassional migraine, which just barely lets me get by.