Breast-Feeding Moms Warned About Codeine Overload

Aug 20, 07:22 AM

Current Headlines: By Claudia Lauer

WASHINGTON -- Breast-feeding mothers who take medications that contain codeine should watch their infants for possible signs of morphine overdose, such as becoming overly sleepy, Food and Drug Administration officials warned Friday.

A new agency advisory said that a small percentage of mothers could have the ability to metabolize codeine at rapid rates, turning it into morphine and putting their babies at risk for overdose. The agency became aware of the issue after the death of a 13-day-old Toronto infant last year was attributed to his mother being an "ultra-rapid metabolizer."

"When codeine enters the body and metabolizes, it changes to morphine," said Dr. Sandra Kweder, the FDA's deputy director of the Office of New Drugs. "That can be transported in the blood and through breast milk."

Kweder said some people have a biological variation in a liver enzyme that makes them capable of changing codeine to morphine more quickly and completely than in others. Although the hereditary rapid- metabolizer gene seems to be rare, the use of codeine is common among postpartum women. It often is prescribed after Cesarean section deliveries, episiotomies and other procedures. Codeine is common in low-grade painkillers such as some forms of Tylenol and even in some nonprescription cough syrups.

The FDA has asked makers of prescription and other codeine- containing drugs to include a specific warning on labels to address the possible danger of passing on morphine through breast milk. However, officials said they do not want to discourage new mothers from breast-feeding.

"Our best advice to physicians prescribing codeine-containing products to nursing mothers is to prescribe the lowest dose needed for the shortest amount of time," said Kweder.

The advisory also warned mothers to be vigilant about monitoring the side effects they might experience, and especially to watch for any effects the drugs may have on infants. Some common symptoms of morphine problems in infants include sleeping for long stretches, having problems breast-feeding, constipation, breathing difficulties and limpness in their arms and legs.

In the Toronto case, two days after a pediatrician visit, the baby died. He had more than six times the safe limit of morphine in his body.

According to Kweder, FDA studies found that between 1 percent and 10 percent of whites and about 3 percent of Asian-Americans and black Americans have the liver enzyme combinations that make them rapid metabolizers.

Northern Africans, Saudi Arabians, and native Africans have a higher risk, some as high as 28 percent.

Originally published by Los Angeles Times.

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