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Case Reports
. 2007 Jan;53(1):33-5.

Safety of codeine during breastfeeding: fatal morphine poisoning in the breastfed neonate of a mother prescribed codeine

Parvaz Madadi, Gideon Koren, James Cairns, David Chitayat, Andrea Gaedigk, J Steven Leeder, Ronni Teitelbaum, Tatyana Karaskov, Katarina Aleksa
Case Reports

Safety of codeine during breastfeeding: fatal morphine poisoning in the breastfed neonate of a mother prescribed codeine

Parvaz Madadi et al. Can Fam Physician. 2007 Jan.

Abstract
in English, French

Question: Recently a newborn died from morphine poisoning when his mother used codeine while breastfeeding. Many patients receive codeine for postlabour pain. Is it safe to prescribe codeine for nursing mothers?

Answer: When a mother is an ultrarapid metabolizer of cytochrome P450 2D6, she produces much more morphine when taking codeine than most people do. In this situation, newborns might be exposed to toxic levels of morphine when breastfeeding. Options to reduce this risk include discontinuing codeine after 2 to 3 days of use and being aware of symptoms of potential opioid toxicity in both mothers and newborns.

QUESTION Un nouveauné est récemment décédé d’un empoisonnement à la morphine parce que sa mère avait pris de la codéine pendant qu’elle allaitait. De nombreuses patientes reçoivent de la codéine pour les douleurs après le travail. Estil sécuritaire de prescrire de la codéine aux mères qui allaitent?

RÉSPONSE Si la mère métabolise ultra rapidement le cytochrome P450 2D6, elle produit beaucoup plus de morphine lorsqu’elle prend de la codéine que la plupart des autres personnes. Dans une telle situation, un nouveauné pourrait être exposé à des taux toxiques de morphine quand il est allaité. Pour réduire le risque, on peut, entre autres, cesser l’utilisation de la codéine après 2 ou 3 jours, et demeurer vigilant face aux éventuels symptômes d’une intoxication aux opioïdes chez la mère et lenourrisson.

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Comment in

  • Morphine in breast milk.
    Young M. Young M. Can Fam Physician. 2007 Jun;53(6):1005; author reply 1005-6. Can Fam Physician. 2007. PMID: 17872775 Free PMC article. No abstract available.

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