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

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. © 2007 The Authors Journal compilation © 2007 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.