U.S. flag

An official website of the United States government

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-.

Cover of Drugs and Lactation Database (LactMed)

Drugs and Lactation Database (LactMed) [Internet].

Show details


Last Revision: June 21, 2021.

Estimated reading time: 1 minute

CASRN: 125-28-0

image 134975551 in the ncbi pubchem database

Drug Levels and Effects

Summary of Use during Lactation

Maternal use of oral narcotics during breastfeeding can cause infant drowsiness, central nervous system (CNS) depression and even death. Like codeine, pharmacogenetics probably plays a role in the extent of CNS depression. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Dihydrocodeine possibly caused severe respiratory depression in one newborn infant whose mother was taking the drug for cough. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of hydromorphone to a few days at a low dosage with close infant monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. Because there is little published experience with dihydrocodeine during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.

Drug Levels

Dihydrocodeine is metabolized via CYP2D6 to the active metabolite, dihydromorphine, which has a potency similar to morphine. Other weakly active metabolites include nordihydrocodeine, which is formed via CYP3A4, and dihydrocodeine-6-glucuronide. Both dihydrocodeine and dihydrocodeine-6-glucuronide are excreted renally.[1]

Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

A woman began taking dihydrocodeine drops for cough twice daily (5.28 mg) beginning on the first day postpartum. One day later, her breastfed infant was difficult to arouse and was not breastfeeding well. The infant had bradycardia, hypoglycemia, and an oxygen saturation of 85%. After 24 hours in the hospital, all symptoms resolved. The symptoms were possibly caused by dihydrocodeine in milk.[2]

Effects on Lactation and Breastmilk

Narcotics can increase serum prolactin.[3] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.

Alternate Drugs to Consider

(Analgesia) Acetaminophen, Butorphanol, Hydromorphone, Ibuprofen, Morphine; (Antitussive) Dextromethorphan


Kirkwood LC, Nation RL, Somogyi AA. Characterization of the human cytochrome P450 enzymes involved in the metabolism of dihydrocodeine. Br J Clin Pharmacol. 1997;44:549–55. [PMC free article: PMC2042888] [PubMed: 9431830]
Eleftheriou G, Butera R, Davanzo F, et al. Dihydrocodeine and breast feeding: A case report. Birth Defects Res A Clin Mol Teratol. 2014;100:540. Abstract.
Tolis G, Dent R, Guyda H. Opiates, prolactin, and the dopamine receptor. J Clin Endocrinol Metab. 1978;47:200–3. [PubMed: 263291]

Substance Identification

Substance Name


CAS Registry Number


Drug Class

Breast Feeding


Analgesic, Opioid


Antitussive Agents

Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.


Related information

Similar articles in PubMed

  • Review Hydromorphone[Drugs and Lactation Database (...]
    Review Hydromorphone
    . Drugs and Lactation Database (LactMed). 2006
  • Review Codeine[Drugs and Lactation Database (...]
    Review Codeine
    . Drugs and Lactation Database (LactMed). 2006
  • Review Oxymorphone[Drugs and Lactation Database (...]
    Review Oxymorphone
    . Drugs and Lactation Database (LactMed). 2006
  • Review Hydrocodone[Drugs and Lactation Database (...]
    Review Hydrocodone
    . Drugs and Lactation Database (LactMed). 2006
  • Review Oxycodone[Drugs and Lactation Database (...]
    Review Oxycodone
    . Drugs and Lactation Database (LactMed). 2006
See reviews...See all...

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...