Use of codeine while nursing may cause fatal overdose for baby
A new FDA warning indicates that codeine side effects could result in a morphine overdose for nursing babies when the drug is taken by a breastfeeding mother who is an ultra-fast metabolizer of codeine. Many new mothers are prescribed codeine following child birth, and some of these women could convert the drug to morphine more rapidly than other people. This could result in higher-than-expected levels of morphine in breast milk, leading to an increased risk of rare, but potentially fatal problems for the baby.
Federal regulators started looking at the risk of codeine side effects in nursing mothers after a medical journal reported on the 2006 death of a 13 day old baby as a result of morphine overdose. The mother took an ordinary dose of codeine and was found to be an ultra-rapid metabolizer of the drug. This specific genetic makeup allows the woman’s body to process codeine with extreme speed.
While it is uncommon for women to be a fast metabolizer, it is not rare. According to the FDA, approximately 1 to 10% of Caucasians, 3% of African Americans, 1% of Hispanics and almost 28% percent of North Africans, Ethiopians and Saudi Arabians have the genetic structure.
Although there are blood tests available for mothers to discover if they are a fast metabolizer of codeine, the FDA is not currently recommending routine testing. Rather, the federal regulators indicate that mothers who are nursing their infants should only take the smallest possible dose necessary and should take it for only a short period of time. They should also closely monitor their baby for signs of problems. There is no indication that mothers should stop breast-feeding their babies due to this warning.
Symptoms of morphine overdose in infants as a result of codeine use by a nursing mother could include:
- Increased sleepiness
- Difficulty breast-feeding
- Trouble breathing
- Limpness
Codeine is generally considered a safe pain killer for post-delivery pains. It is available as a prescription combined with otherr medications or in some over-the-counter cough syrups. One of the more popular medications containing the drug is Tylenol with Codeine, manufactured by Johnson & Johnson.
The FDA has requested that warnings of codeine side effects be added to all products containing the drug. The warning will indicate that certain nursing mothers who are “ultra-rapid metabolizers of condeine” may be at risk of causing a morphine overdose for their child. If a baby, who is nursing from a mother taking codeine, appears unusually sleepy or has unusual symptoms or problems, immediate medical attention should be sought.
