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

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Drugs and Lactation Database (LactMed) [Internet].

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Dihydrocodeine

Last Revision: January 18, 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 dihydrocodine 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

References

1.
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]
2.
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.
3.
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

Dihydrocodeine

CAS Registry Number

125-28-0

Drug Class

Breast Feeding

Lactation

Analgesic, Opioid

Narcotics

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.

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