Oxycodone not safe alternative to codeine for breastfed neonates
MedWire News: Using oxycodone to treat postoperative pain during the postpartum period is not a safer alternative to codeine for breastfed neonatal infants or their mothers, contrary to previous thinking, a study suggests.
Future prospective and pharmacologic studies are needed to investigate other factors related to maternal oxycodone use and neonatal central nervous system (CNS) depression, write Jessica Lam (University of Toronto, Ontario, Canada) and co-authors in The Journal of Pediatrics.
Due to recent concerns about neonatal CNS depression after codeine use in breastfed infants, some clinicians have started to prescribe oxycodone, a semisynthetic opioid, instead of codeine during the postpartum period, the authors explain. However, the neonatal safety of the drug, which exhibits high oral bioavailability and rapid oral absorption, has not, until now, been established.
The authors retrospectively compared three cohorts among 533 breastfeeding mother-infant pairs exposed to oxycodone (n=139), codeine (n=210), or acetaminophen only (n=184). Standardized questionnaires were administered to the mothers during the postpartum period to identify whether maternal and neonatal health outcomes, with a focus on CNS depression, were temporarily related to exposure to the three drugs.
CNS depression in infants was defined as sleepiness/lethargy or not waking up for feeding during the period of drug exposure via breast milk. Sedation was classified as symptomatic of CNS depression in mothers.
Overall, 20.1% of mothers who received treatment with oxycodone reported neonatal CNS depression compared with just 0.5% of mothers in the acetaminophen-only group and 16.7% of mothers in the codeine group, corresponding to respective odds ratios of 46.16 and 0.79.
Mothers who received treatment with oxycodone and had symptomatic infants took significantly higher doses of the drug, at a median of 0.40 mg/kg per day, than those who had asymptomatic infants, at 0.15 mg/kg per day. However, the authors note, none of the mothers exceeded the maximum recommended dosage of 40 mg per day.
Symptomatic infants breastfed by mothers who received oxycodone had significantly longer consecutive hours of uninterrupted sleep, at a median of 5 hours per day, than asymptomatic infants, who slept 4 hours per day.
In addition, mothers medicated with oxycodone or codeine who had symptomatic babies were significantly more likely to experience CNS depression themselves. Indeed, such mothers who received oxycodone were 8.86 times as likely to experience CNS depression as those with asymptomatic babies, while those who received codeine were 21.1 times as likely to experience CNS depression.
In a related commentary, John van den Anker (Children's National Medical Center, Washington, USA) says that "a more individualized approach to using this drug in this patient subpopulation must be embraced to minimize the chance for serious adverse events in the neonate."
By Piriya Mahendra