Doctors weigh alternatives to codeine to avoid overdoses in infants

Canadian doctorswill look next week at the best pain relief alternatives for nursing mothers in the wake of research that suggests codeine may be deadly for some infants.

At thejoint meeting of the Society of Obstetricians and Gynecologists of Canada and the Canadian Paediatric Society, members will discuss which painkillers are appropriate to use during breastfeeding, and decide whatsteps they should take to establishguidelines on the topic.

Codeine is metabolized into morphine and is commonly used for pain relief in combination with acetaminophen.

While the American Academy of Pediatrics currently lists codeine as compatible with breastfeeding, studies show some women may end up metabolizing it into morphine at a faster rate, potentially exposing a breast-fed infant to an excess dose.

Dr. Gideon Koren, director of the Motherisk program at Toronto's Hospital for Sick Children, and his colleagues found 17 of 72 infants studied became sedated or experienced abnormal breathing after their mothers took codeine.

Nearly half of infants in North America are delivered by caesarean section or after episiotomy, and their mothers may need pain relievers, such as Tylenol 3 or other analgesics that combine codeine with acetaminophen.

Alternativesavailable

"However, our study confirms that codeine as a treatment for pain may be unsuitable and cannot be considered safe for all breastfed infants," Koren said.

Non-codeine medications, such asacetominophen in combination withnon-steroidal anti-inflammatories or NSAIDS,and icing are other possibilities to easepain following childbirth.

For any woman to receive any additional benefit from the codeine combination than extra-strength acetaminophen, nine others would have to be treated, said Dr. Peter von Dadelszen, a professor of obstetrics and gynecologyat the University of British Columbia and a consultant in maternal-fetal medicine at BC Women's Hospital.

Those takingcodeinemay become constipated and drowsy. For women who have delivered recently and are constipated, they may face the pain of having to strain with a recent abnominal incision, and the stool may pass near recent trauma to the vaginaand or perineum,von Dadelszen added in an e-mail interview.

Health Canada has not changed labelling on the drug to highlight the potential risk to nursing mothers, but it is considering doing so.

Hospitals are consideringpulling the combination pills fromshelves or restricting theiruse.

In the meantime,pediatric pharmacologists advise mothers taking painkillers containing codeine to be extremely careful and watch for signs of increased sleepiness or overdose.

The advicealso applies to children taking painkillers containing codeine.