Cocodamol and breastfeeding - is it OK?

[appledumpling]

I have an ongoing back problem which has become more of an issue as DS has grown and become heavier to lift.

My GP has prescribed cocodamol but is it OK to take while breastfeeding? He said it would make DS drowsy and the leaflet inside the pack points out that it can be addictive so I'm a bit concerned that it's not the best thing to take. On the other hand I would really love a pain-free day...

Any thoughts greatly appreciated.

Oh, and Happy New Year!

I (and I suspect most women who have had them) was prescribed co-codamol after my CS. It didn't appear to make my DS drowsy

Happy new year - hope you have a painfree one

Cocodamol is codeine with paracetamol. Paracetamol is perfectly safe. According to "medications and Mother's Milk" (definitive guide used by breastfeeding counsellors), coedine is catagorised as L3. This is "moderately safe" - no controlled studies on bf mothers however only minimal risk to infant. The section on codeine in the book says the amount secreted into breastmilk is low and dose dependant.

i got given cocodamol in hospital after both my births & breastfed both times. i think you'll be fine. but i do find codeine makes me very drowsy.

Thank you all for the quick responses. I was probably being over-cautious (as usual ).

I was given cocodamol for afterpains after having both dd and ds and also after an operation when dd was 5 weeks old and for strained muscles after ds-can't remember it affecting dd and it certainly doesn't make ds drowsy. Only thing is I find it makes my mouth really dry so I need to drink loads more than usual (but thats no bad thing when bf especially as i have a tendancy to forget to drink enough!)

Yes, it's not contraindicated with BFing

No, cocodamol has been recently been reclassified as NOT being suitable for breastfeeding mums anymore. Let me have a look for the study which said this.

just had it prescribed today. My doctor knew i am bf so i ok. I have taken it before and ds been fine

Depending on how strong the strength of the codenine is in the cocodamol pills and the age of your breastfed baby the risk might only be small or nonexistant but I thought I better mention it so you can decide whether to continue taking these pills or not or to seek further information.

Study on Recent Problems with Codeine

Painkiller Drug list for Breastfeeding Mums

I can't remember the level of codine in the painkillers I was given. All I remember is the A&E doctor said they were save for breastfeeding mums but the drug line said no they were not safe. But they might of been stronger pills than you have.

save safe

mehdi, It might be nothing and it might not apply to you and the drugs you are taking, depending on the actual level of codine in the painkillers you are taking and age of your breastfed child.

But as this change in status for codine is a recent thing, are you 100% sure that your GP has read that study ? Doctors are only human and the lovely well meaning A&E doctor I saw a couple of months ago, gave me the incorrect information and send me home with a codenine based drug which were not suitable for breastfeeding.

However if I was in your situation I would consider ringing the Drugline number I posted and just checking the facts out for myself, I'm glad I did.

Sorry to contradict you Babieseverywhere, but that helpline is meant to be called by breastfeeding counsellors and health professionals only, not by mums.

babieseverywhere - codeine (or any opiate) is the only seriously strong painkiller available and is regularly given to women in labour and in the first few weeks after birth if they've had a cs.

There is nothing else that's more effective for great pain. This is really bad news

IlanaK, Opps, I didn't realise that. I was given the number by a professional but didn't realise it was private as such.

I am not a drug expert, but I am a bf counsellor with a recent copy of Hale (the book I mentioned earlier) in front of me. Although it is classed as L3 which is not the lowest classification, it IS considered low risk. I think you have to make your own decision on this. If it has been prescribed to you because you need it, and you are not taking it in large doses, and your baby is not newborn, you have to factor it as a low low risk.

appledumpling,

I have asked for the telephone to be removed from my second post (as I now know thanks to IlanaK, it is just for HCA's not us mums

Hopefully between all the other links/posts on your thread, you'll have enough information to make an informed choice

All the best and I hope your back improves very soon.

I vaguely remember reading a news item recently that codeine shouldn't be automatically prescribed for all Mums because there are minority of women who have a gene which turns codeine into morphine and which creates a toxic mixture in bm.

here

It says 1% of caucasians carry the gene.

Sorry if that has already been posted - haven't read rest of thread.

I'm not sure where that leaves the whole BF and Codeine thing. I'm a bit confused because I was given morphine after both sections and I BF?

According to this list Morphine is still fine.

I was given both codeine and morphine after cs and was expressing for ds who was in SCBU. I specifically remember asking about the milk and was told it was fine by the mw - hope they were right! Bit late for ds now though, he seems OK

So if it's 1% of white women does it mean if u not u don't have that gene so it's ok to take?

Not all resources have changed to be up to date on this. Breastfeeding network fact sheet at

breastfeedingnetwork.org.uk/wp-content/dibm/codeine%20and%20brestfeeding.pdf

And some NHS info

www.sps.nhs.uk/articles/codeine-and-breastfeeding-is-it-safe-and-what-are-the-alternatives/

"Until recently, codeine was considered the preferred opioid for use in breastfeeding mothers. However a fatal case of morphine toxicity in a breastfed infant following maternal use of codeine has lead the MHRA and EMA to contraindicate its use by breastfeeding women."

It goes on to highlight other options (than paracetamol) that could be used. You could check "drugs in breast milk" support contacts (now via email / Facebook)

www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/

Or back to the doctor.

Just to clarify something said above - everyone converts codeine to morphine - that's how codeine works.

However, it's true that there is variability in how well each individual converts it - up to a quarter will convert it really poorly/slowly and won't get a good pain relief effect at all.
A small number (I suspect the 1% mentioned above) will be very fast converters - meaning that it turns to morphine very quickly giving you a big spike in the blood level. This might be why it has started to be cautioned against using codeine - for those individuals it could potentially be a problem, though I haven't read the study above yet.

However, I would think that it should be fine for the large majority of people, though it might not work well for about 1 in 4.

Interestingly, morphine is arguably safer as there's less variation in how people process it and its painkilling mechanism is the same.

(sorry if that was long, analgesics are a pet topic of mine (medic))

Also had this question 🙈 If you were to take one of the 8/500 then feed for 20 mins would it still go to babe? Or would it take a little bit of time like alcohol does??

codeine is contraindicated for breastfeeding mothers and small children.

www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Codeine-containing_medicines/human_referral_prac_000008.jsp&mid=WC0b01ac05805c516f

Because of a risk of breathing problems, the use of codeine medicines for pain relief in children has been restricted: these medicines are now only to be used to treat acute (short-lived) moderate pain in children above 12 years of age, and only if it cannot be relieved by other painkillers such as paracetamol or ibuprofen.

All children (aged below 18 years) who undergo surgery for the removal of the tonsils or adenoids to treat obstructive sleep apnoea (frequent interruption of breathing during sleep) should not be given codeine as they are more at risk of breathing problems.

Mothers who are breastfeeding should not take codeine because codeine can pass to the baby through breast milk

Patients who are known to be ‘ultra-rapid metabolisers’, which means that they are more at risk of serious side effects with codeine, should not use codeine as pain relief.

Parents and caregivers who notice any of the following symptoms in a patient given codeine should stop giving the medicine and seek medical attention immediately: slow or shallow breathing, confusion, sleepiness, small pupils, feeling or being sick, constipation and lack of appetite.

If you or your child are being treated with codeine and have any questions or concerns about your treatment, speak to your doctor or pharmacist.