Mom, watch your medication

The U.S. Food and Drug Administration has warned breast-feeding mothers who are taking codeine-based medications about the possible effects of the drug on their nursing infants.

In an advisory posted to its website Friday (Aug. 17), the FDA says infants are in danger of getting a morphine overdose if the mother is an ultra-rapid metabolizer of codeine.

The FDA reviewed all information on codeine after a 13-day-old nursing infant died of morphine overdose in Toronto last year, as reported in a medical journal. The morphine came from the mother’s milk, which had abnormally high levels of morphine; the mother was taking codeine to relieve pain from episiotomy. Genetic tests proved that the mother metabolized codeine at an ultra rapid rate.

Codeine is an active ingredient in prescription and non-prescription medicines used to relieve pain or treat cough. Once ingested, the body converts some of it into morphine, which helps relieve the pain. But the genetic makeup in some people, involving a liver enzyme combination, causes them to convert codeine at a faster and more complete rate than others. These ultra-rapid metabolizers get high levels of morphine in their blood after taking codeine; and if they are breast-feeding mothers, they’ll have high levels of morphine in their breast milk.

Codeine is considered in medical practice as the safest option among narcotic pain relievers for nursing mothers and infants. The FDA advises physicians to prescribe only the lowest dose to nursing mothers and for the shortest duration needed. Women who have just given birth take it as pain relievers, after caesarean sections and episiotomies. Codeine is also common in low-grade painkillers and nonprescription cough syrups.

Tips for nursing mothers taking codeine (or any narcotic pain reliever) to watch for signs of overdose in babies:
* Breast fed babies should normally nurse every two to three hours. Observe closely if they refuse to nurse.
* Breast fed babies should not sleep more than four hours at a time. Watch closely for increased sleepiness.
* Babies may have difficulty breathing.
* Babies may show increasing limpness.

Nursing mothers getting above-normal morphine levels will also show extreme sleepiness, breathing difficulty, confusion, or severe constipation. Mothers should not take too long to call their doctor if they observe disturbing signs.

The likelihood of being an ultra-rapid metabolizer shows variation among different groups. FDA studies show that the chances are 1% to 10% among whites and about 3% among Asian Americans and African Americans. But for North Africans, Saudis and native Africans, the chances can reach 28%.