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Oxycodone as a component of multimodal analgesia for lactating mothers after Caesarean section: relationship between maternal plasma, breast milk and neonatal plasma levels

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Seaton, S and Reeves, MD and McLean, SR (2007) Oxycodone as a component of multimodal analgesia for lactating mothers after Caesarean section: relationship between maternal plasma, breast milk and neonatal plasma levels. Australian and New Zealand Journal of Obstetrics and Gynaecology, 47. pp. 181-185. ISSN 0004-8666

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Abstract

Background:
Oxycodone has become popular for post-Caesarean section (CS) analgesia yet it is not currently
recommended for use in breast-feeding mothers because of limited information on its excretion into breast milk.
Aim:
To investigate the relationship between maternal ingestion of oxycodone after CS and the resultant maternal
plasma, breast milk and neonatal plasma drug levels up to 72-h post-partum.
Methods:
Fifty breast-feeding mothers taking oxycodone had blood and breast milk samples analysed for
oxycodone levels at 24 h intervals after CS. Forty-one neonates had blood samples taken at 48 h.
Results:
Oxycodone was detected in the milk of mothers who had taken any dose in a 24-h period, with significant
correlation between maternal plasma and milk levels (
R
2
= 0.81). The median milk:plasma (M:P) ratio for the same
period was 3.2:1. Over the subsequent 48 h, the relationship between plasma and milk levels was less strong
(
R
2
= 0.59) and there was a larger range of M:P levels with evidence of persistence of oxycodone in the breast milk
of some mothers. Oxycodone levels up to 168 ng/mL were detected in breast milk (20% > 100 ng/mL). Oxycodone
was detected in the plasma of one infant.
Conclusions:
Oxycodone is concentrated in human breast milk up to 72-h post-partum. Breastfed infants may
receive > 10% of a therapeutic infant dose. However, maternal oxycodone intake up to 72-h post-CS poses only
minimal risk to the breast-feeding infant as low volumes of breast milk are ingested during this period.

Item Type: Article
Keywords: breast milk, Caesarean section, neonate, oral analgesia, oxycodone.
Journal or Publication Title: Australian and New Zealand Journal of Obstetrics and Gynaecology
Publisher: Blackwell Publishing Asia Pty Ltd
Page Range: pp. 181-185
ISSN: 0004-8666
Date Deposited: 07 Apr 2008 14:10
Last Modified: 18 Nov 2014 03:33
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