Methadone breast-feeding

Methadone Significant (See heroin.) Under close physician supervision, breast-feeding can be continued. Signs of opioid withdrawal in the infant may occur if mother stops taking methadone or stops breast-feeding abruptly. 

In patients with reduced respiratory reserve, such as those with emphysema, severe obesity, cor pulmonale, and kyphoscoliosis, opioids must be used with caution. The relative benefits and harms of using opioids in patients taking monoamine oxidase inhibitors, those with a history of drug abuse, asthma, hepatic impairment, hypotension, raised intracranial pressure, or head injury, and during pregnancy or breast feeding, should be carefully considered. Dextropropoxyphene, pethidine, and methadone should be used with caution (SEDA-21, 85). 

Opioids (especially methadone and heroin) are the most common cause of serious neonatal drug withdrawal symptoms. Other dmgs for which a withdrawal syndrome has been reported include phencyclidine (POP), cocaine, amphetamines, tricyclic antidepressants, phenothiazines, benzodiazepines, barbiturates, ethanol, clonidine, diphenhydramine, lithium, meprobamate, and theophylline. A careful dmg history from the mother should include illicit drugs, alcohol, and prescription and over-the-counter medications, and whether she is breast-feeding. 

Pregnancy The roles of buprenorphine and methadone in the clinical management of opioid dependence during pregnancy and breast feeding have been reviewed [190 ]. The dosages must be tailored to the needs of each opioid-dependent pregnant woman. 

Breast-Feeding A retrospective chart review looked at methadone-exposed infants compared to nonexposed infants finding that methadone-exposed infants were significantly smaller for gestational age [51 ]. This weight loss was more prominent in methadone-exposed infants who were formula fed. 

Dryden C, Young D, Campbell N, Mactier H. Postnatal weight loss in substitute methadone-exposed infants impUcations for the management of breast feeding. Arch Ms Child May 2012 97(3) F214-6. 

---