PIC QUESTION OF THE WEEK: 2/08/08 Q: Can a child breastfeed while the mother is receiving methadone? A: Methadone is an opiate analgesic prescribed for moderate to severe pain. It is also frequently used in structured maintenance programs to reduce the use of heroin and abuse of other opiates. Methadone remains the therapy of choice for prevention of opiate abuse during pregnancy and the postpartum period. Many studies indicate that the passage of methadone into breast milk is minimal. In most cases, the amount of drug secreted is ≤3% of the mother’s dose. Maternal doses as high as 105 mg/day have been administered without apparent adverse effects in the neonate. Excessive concentrations of methadone in breast milk would usually manifest as sedation, respiratory depression, etc. Breastfeeding may be beneficial for infants whose mothers have been maintained on methadone during pregnancy. The amount of drug transferred to the infant in breast milk may not be sufficient to completely prevent the signs of neonatal abstinence syndrome; however, the severity and frequency of these episodes may be reduced. Signs of withdrawal may be observed in 60% to 90% of infants exposed to methadone during pregnancy. General signs of neonatal withdrawal include irritability, hypertonicity, tremulousness, high-pitched cry, etc. In addition, the child may thrash at the breast and/or clamp down on the nipple and not actually suckle. Breastfeeding during administration of methadone may also delay the onset of neonatal withdrawal. Mothers taking methadone who discontinue breastfeeding should gradually wean the infant to avoid inducing the abstinence syndrome. The usual infant dose of methadone required for treatment of neonatal abstinence syndrome is 50-100 mcg/kg every 6 to 12 hours. It is generally recommended not to commence methadone treatment in a breastfeeding mother who was not maintained on the drug during pregnancy. The benefits of breastfeeding are significant and include bonding of the mother and child, transfer of passive immunity to the infant, and protection against sudden infant death syndrome. The American Academy of Pediatrics guideline on the transfer of drugs into human milk (Pediatrics 2001;108:776-88) lists methadone as usually compatible with breastfeeding. Based on available evidence, maternal use of methadone during breastfeeding is considered safe. References: • • • •
Jansson LM, Choo RE, Harrow C, et al. Concentrations of methadone in breast milk and plasma in the immediate perinatal period. J Hum Lact 2007;23:184-90. Jansson LM, Velez M, Harrow C. Methadone maintenance and lactation: a review of the literature and current management guidelines. J Hum Lact 2004;20:62-71. Hale TW. Medications and mothers’ milk. 12th ed. Amarillo:Hale Publishing;2006. National Library of Medicine. LactMed. http://www.toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT (Accessed February 6, 2008)
Rachael L. Slogan and Kevin M. Kunkle, Pharmacy Clerkship Students The PIC Question of the Week is a publication of the Pharmaceutical Information Center, Mylan School of Pharmacy, Duquesne University, Pittsburgh, PA 15282 (412.396.4600).