毒理性
◉ 母乳喂养期间使用总结:氢可酮是一种阿片类麻醉药。苯氢可酮是一种氢可酮的前药,在胃肠系统中迅速转化为氢可酮。哺乳期母亲口服麻醉药可能会导致婴儿昏睡,严重的中枢神经系统抑制。新生儿似乎对即使是很小的麻醉性镇痛药剂量都非常敏感。一旦母亲的乳汁开始分泌,最好使用非麻醉性镇痛药来控制疼痛,并限制母亲口服氢可酮的时间为2到3天,最大剂量每天30毫克,并密切监测婴儿。如果婴儿表现出过度昏睡(比平常更甚)、哺乳困难、呼吸问题或无力,应立即联系医生。
◉ 对哺乳婴儿的影响:一名正在哺乳的母亲服用20毫克口服氢可酮,并每隔4小时与1300毫克扑热息痛(对乙酰氨基酚)联合使用,治疗疼痛的乳头念珠菌病和乳腺炎,她的18天大的婴儿变得昏昏欲睡并“一整天大部分时间都在睡觉”。母亲将剂量减少了一半,婴儿似乎不再经历昏昏欲睡或过度嗜睡。婴儿的症状可能是由母亲的氢可酮引起的。
一名5周大的哺乳婴儿变得发绀并需要口对口人工呼吸和插管。婴儿的尿液中检测到阿片类药物呈阳性,并对纳洛酮有积极反应;意识水平在2天内有所改善并成功拔管。婴儿的母亲承认在哺乳前服用了氢可酮-扑热息痛复方制剂和甲基吗啡(美沙酮),这些药物是为偏头痛头痛而开的处方。婴儿的症状可能是由母亲的阿片类药物使用引起的。
◉ 对泌乳和母乳的影响:麻醉药可以增加血清催乳素。然而,对于已经建立泌乳的母亲,催乳素水平可能不会影响她的哺乳能力。
◉ Summary of Use during Lactation:Hydrocodone is an opioid narcotic. Benzhydrocodone is a hydrocodone prodrug that is rapidly converted into hydrocodone in the gastrointestinal tract. Maternal use of oral narcotics during breastfeeding can cause infant drowsiness, and severe central nervous system depression. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of oral hydrocodone to 2 to 3 days at a maximum dosage of 30 mg daily 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.
◉ Effects in Breastfed Infants:The 18-day-old infant of a breastfeeding mother became groggy and "slept for most of the day" while the mother was taking 20 mg of oral hydrocodone combined with 1300 mg of acetaminophen every 4 hours for painful nipple candidiasis and mastitis. The mother decreased her dose by one-half and the infant apparently no longer experienced grogginess or hypersomnolence. The infant's symptoms were probably due to the maternal hydrocodone.
A 5-week-old breastfed infant became cyanotic and required mouth-to-mouth resuscitation and intubation. The infant's urine was positive for opioids and the infant responded positively to naloxone; the level of consciousness improved over 2 days and extubation was accomplished. The infant's mother admitted to taking a hydrocodone-acetaminophen combination product and methadone that had been prescribed for migraine headache before she was breastfeeding. The infant's symptoms were probably due to the maternal opiate use.
◉ Effects on Lactation and Breastmilk:Narcotics can increase serum prolactin. However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.
来源:Drugs and Lactation Database (LactMed)