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Motherisk News: SickKids scientist confirms the risks of codeine use and breastfeeding

Toronto - Using pain treatments which contain codeine may be risky for some breastfeeding mothers, according to research published this week by researchers at The Hospital for Sick Children (SickKids). Dr. Gideon Koren, Senior Scientist in the Child Health Evaluative Sciences program at SickKids Research Institute, Director of Motherisk, Professor of Paediatrics at the University of Toronto, and Richard and Jean Ivey Chair in Molecular Toxicology in the Schulich School of Medicine & Dentistry at The University of Western Ontario, published research in the journal, Clinical Pharmacology & Therapeutics which suggests that the codeine used in some pain relief drugs can actually have harmful and even fatal results for infants when ingested by some breastfeeding mothers.

"With nearly half of all infants in North America being delivered by caesarean section or after episiotomy, there is clearly a requirement for pain relief for mothers," says Koren, lead author of the study. "However, our study confirms that codeine as a treatment for pain may be unsuitable and cannot be considered safe for all breastfed infants."

Codeine is commonly used for pain relief and is recommended by the American Academy of Pediatrics as being compatible with breastfeeding. Following numerous reports through the Motherisk counseling service and the tragic death of an infant who died from an overdose of morphine acquired from breast milk, Koren and his team, located at SickKids and Western, investigated these negative reactions.

Codeine is a 'prodrug' which means that on its own it is relatively inactive. The pain relieving attributes are only activated when it is metabolized, or transformed by the body into a more active pain relieving compound, morphine. Some individuals have a genetic variance which causes them to metabolize codeine at a rapid rate, producing significantly more morphine in their system than most of the population. While this genetic predisposition is rare, women who possess it and who take codeine for pain while breastfeeding can end up exposing their babies to high levels of morphine through their breast milk. This can cause babies to experience central nervous system depression as a result.

"The good news is that those breastfeeding children who were exposed to these high levels of morphine showed dramatic improvement once they were taken off the morphine tainted breast milk," says Koren. "By removing the exposure, most children will demonstrate a complete reversal of symptoms and show no long-term adverse effects."

The study was funded by Genome BC , Genome Canada , CIHR, the Ivey Chair in Molecular Toxicology, the Research Leadership for Better Pharmacotherapy during Pregnancy and Lactation, and SickKids Foundation.

The Hospital for Sick Children (SickKids), affiliated with the University of Toronto, is Canada's most research-intensive hospital and the largest centre dedicated to improving children's health in the country. As innovators in child health, SickKids improves the health of children by integrating care, research and teaching. Our mission is to provide the best in complex and specialized care by creating scientific and clinical advancements, sharing our knowledge and expertise and championing the development of an accessible, comprehensive and sustainable child health system. For more information, please visit www.sickkids.ca . SickKids is committed to healthier children for a better world.

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The information on this website is not intended as a substitute for the advice and care of your doctor or other health-care provider. Always consult your doctor if you have any questions about exposures during pregnancy and before you take any medications.

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The Hospital for Sick Children (SickKids) is a health-care, teaching and research centre dedicated exclusively to children; affiliated with the University of Toronto. For general inquires please call: 416-813-1500.

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