Promethazine With Codeine | Promethazine Hydrochloride And Codeine Phosphate Syrup Breastfeeding

Nutrients from the food that you eat passes to your breast milk. Its good idea to take healthy diet while breastfeeding. You may need to consume more calories per day to support healthy body system. Some time it gets necessary take medicine while you are breastfeeding and as other food items passes into breast milk, medicine passes as well hence it becomes obvious to understand its effects while breastfeeding. We have analyzed many medications and in this sheet we will present some fact and known information associated with Promethazine With Codeine | Promethazine Hydrochloride And Codeine Phosphate Syrup while breast-feeding.

What is Promethazine With Codeine | Promethazine Hydrochloride And Codeine Phosphate Syrup ?


Promethazine with codeine syrup is indicated for the temporary relief of coughs and upper respiratory symptoms associated with allergy or the common cold.

Can I use Promethazine With Codeine | Promethazine Hydrochloride And Codeine Phosphate Syrup while breastfeeding?

Promethazine With Codeine | Promethazine Hydrochloride And Codeine Phosphate Syrup high risk while breastfeeding
Promethazine With Codeine | Promethazine Hydrochloride And Codeine Phosphate Syrup consists two active ingredients Promethazine hydrochloride and Codeine phosphate and as per our analysis of both we have determined the Promethazine With Codeine | Promethazine Hydrochloride And Codeine Phosphate Syrup is unsafe during breastfeeding. We recommend you to check both ingredients below for better understanding of Promethazine With Codeine | Promethazine Hydrochloride And Codeine Phosphate Syrup in breastfeeding.

Statement of Manufacturer/Labeler about breastfeeding usage
Nursing Mothers: It is not known whether promethazine is excreted in human milk. Codeine is secreted into human milk. In women with normal codeine metabolism (normal CYP2D6 activity), the amount of codeine secreted into human milk is low and dose-dependent. Despite the common use of codeine products to manage postpartum pain, reports of adverse events in infants are rare. However, some women are ultra-rapid metabolizers of codeine. These women achieve higher-than-expected serum levels of codeine's active metabolite, morphine, leading to higher-than-expected levels of morphine in breast milk and potentially dangerously high serum morphine levels in their breastfed infants. Therefore, maternal use of codeine can potentially lead to serious adverse reactions, including death, in nursing infants. The risk of infant exposure to codeine and morphine through breast milk should be weighed against the benefits of breastfeeding for both the mother and baby. Caution should be exercised when codeine is administered to a nursing woman. If a codeine-containing product is selected, the lowest dose should be prescribed for the shortest period of time to achieve the desired clinical effect. Mothers using codeine should be informed about when to seek immediate medical care and how to identify the signs and symptoms of neonatal toxicity, such as drowsiness or sedation, difficulty breastfeeding, breathing difficulties, and decreased tone, in their baby. Nursing mothers who are ultra-rapid metabolizers may also experience overdose symptoms such as extreme sleepiness, confusion, or shallow breathing. Prescribers should closely monitor mother-infant pairs and notify treating pediatricians about the use of codeine during breastfeeding (see WARNINGS - Death Related to Ultra-Rapid Metabolism of Codeine to Morphine ). Caution should be exercised when promethazine with codeine syrup is administered to a nursing woman.

Promethazine With Codeine | Promethazine Hydrochloride And Codeine Phosphate Syrup Breastfeeding Analsys


Promethazine hydrochloride while Breastfeeding

Low Risk

CAS Number: 60-87-7

1st-generation-antihistamine and phenothiazine-type drug with a strong sedative effect. At latest update relevant published data on excretion into breast milk were not found. It may decrease prolactin levels and interfere with milk production during the first few weeks after birth (Pontiroli 1981, Messinis 1985).Pharmacokinetic data (high volume of distribution and high plasma protein-binding capacity) would render it unlikely a significant passage into the breastmilk.In addition, a low oral bioavailability would hinder a further passage to infant’s plasma through the ingested breastmilk, except on premature infants and immediate neonatal period when there may be an increased intestinal permeability.There are doubts about any association with Sudden Infant Death Syndrome (SIDS) (Kahn 1982, Stanton 1983). It may be considered compatible with breastfeeding on isolated doses such as those used for pre-surgical medication or traveler's dizziness (WHO 2002). Avoid a repeated use as it may cause drowsiness in the infant.Avoid using it in the immediate neonatal period (first 4 to 6 weeks after birth) and in case of prematurity. If used, follow-up the infant for drowsiness and feeding issues. It is not recommended bed-sharing when taking this medication (UNICEF 2006, ABM 2008, Landa 2012, UNICEF 2013).

Codeine phosphate while Breastfeeding

Unsafe

CAS Number: 76-57-3

Compound of cough and pain medication. The cytochrome P450-CYP2D6 enzyme catalyzes morphine. It is excreted in breast milk in small amounts, much lower than the dose used for newborns and infants. The plasma levels of infants whose mothers take them are very low, less than usual therapeutic levels and assuming an insignificant relative dose, less than 1.5% (Meny 1993, Naumburg 1988, Findlay 1981), so it was considered safe for use during breastfeeding (Bar-Oz 2003, WHO 2002, AAP 2001, Moretti 2000, Spigset 2000, Mitchell 1999, Meny 1993). However, excessive sedation in the mother or infant may occur if they are rapid metabolizers of codeine to morphine due to an excess of the gene linked to the P450-2D6 enzyme: this occurs in <1% of Chinese, Japanese and Hispanic people; 3% African Americans; 1-10% of Caucasians and 16-29% of North Africans, Ethiopians and Saudis (Halder 2015, Sachs 2013). The genetic diagnosis of this characteristic is not available in usual clinical practice (Madadi, 2011). Codeine through breast milk has been linked to the appearance of neonatal apnea (Naumburg, 1988), drowsiness (Ito, 1993), neurological depression (Madadi, 2008) and, above all, a fatal outcome: a newborn whose mother had this genetic abnormality died at 13 days; the mother was taking 60 mg of codeine twice daily, morphine levels were normal in breast milk, but very high in the child's plasma (Madadi 2007, Koren 2006). Subsequently, the causality of codeine in this case has been called into question (Bateman 2008, Ferner RE 2008, Young 2007). A link has been found between the use of codeine during pregnancy and breastfeeding and the risk of developing neuroblastoma in the infant (Cook, 2004). Because of all this, and with newborns having a limited capacity for opioid elimination (Willmann, 2009) and the existence of more effective alternatives, many authors and institutions advocate completely discouraging its use in infants and breastfeeding mothers (FDA 2017, Al-Adhami 2016, Lazaryan 2015, AEMPS 2015, Sachs 2013, EMA 2013). Other authors advocate cautious use (some even in the case of rapid metabolizers), using the lowest possible effective dose and for no more than 4 days and monitoring for signs of sedation in mother and infant (Royal Berkshire-NHS 2016, Halder 2015, Reece-Stremtan-ABM Protocol#21 2015, Chow 2015, Kelly 2013, UKMi NHS 2013, Rowe 2013, Montgomery-ABM protocol#15 2012, Amir 2011, Madadi 2009, Madadi 2007, FDA 2007). The use of non-steroidal anti-inflammatory drugs (NSAIDs) better controls pain and with fewer side effects than codeine alone or in combination with paracetamol (Palanisamy 2014, Hendrickson 2012, van den Anker 2012, Madadi 2009, Nauta 2009, Willmann 2009), and codeine is not included either in international consensus on the treatment of migraines (Bordini 2016, Worthington 2013). Follow WHO standards for childbirth attendance, reduce cesarean sections and episiotomies, and therefore the need for analgesics in the first few days.


Promethazine With Codeine | Promethazine Hydrochloride And Codeine Phosphate Syrup Breastfeeding Analsys - 2


Promethazine hydrochloride while Breastfeeding

CAS Number: 60-87-7

Based on minimal excretion of other phenothiazine derivatives, it appears that occasional short-term use of promethazine for the treatment of nausea and vomiting poses little risk to the breastfed infant. With repeated doses, observe infants for excess sedation. Because promethazine can lower basal prolactin secretion, promethazine might interfere with the establishment of lactation if given during labor, before lactation is well established or with a sympathomimetic such as pseudoephedrine. An antiemetic without potent histamine blocking action is preferred in nursing mothers.

Codeine phosphate while Breastfeeding

CAS Number: 76-57-3

Maternal use of codeine during breastfeeding can cause infant drowsiness, central nervous system depression and even death, with pharmacogenetics possibly playing a role.[1][2] Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of oral codeine to 2-4 days at a low dosage with close infant monitoring, especially in the outpatient setting.[2][3][4][5] If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately.[6] Excessive sedation in the mother often correlates with excess sedation in the breastfed infant. Following these precautions can lower the risk of neonatal sedation.[7] Numerous professional organizations and regulatory agencies recommend that other agents are preferred over codeine or to avoid codeine completely during breastfeeding;[8][9][10][11][12] however, other opioid alternatives have been studied less and may not be safer.[13]



I am nursing mother and I have already used Promethazine With Codeine | Promethazine Hydrochloride And Codeine Phosphate Syrup, what should I do?

If you observer abnormal behavior or any other health issue in infant then you should immediately call 911 or contact other contact other emergency service provider in your area otherwise closely monitor the baby and inform your doctor about your Promethazine With Codeine | Promethazine Hydrochloride And Codeine Phosphate Syrup usage and time interval of breastfeeding.


My doctor has prescribed me Promethazine With Codeine | Promethazine Hydrochloride And Codeine Phosphate Syrup, what should I do?

If your doctor knows that you are breastfeeding mother and still prescribes Promethazine With Codeine | Promethazine Hydrochloride And Codeine Phosphate Syrup then there must be good reason for that as Promethazine With Codeine | Promethazine Hydrochloride And Codeine Phosphate Syrup is considered unsafe, It usually happens when doctor finds that overall advantage of taking outweighs the overall risk.


If I am using Promethazine With Codeine | Promethazine Hydrochloride And Codeine Phosphate Syrup, will my baby need extra monitoring?

Yes, Extra monitoring is required if mother is using Promethazine With Codeine | Promethazine Hydrochloride And Codeine Phosphate Syrup and breastfeeding as it is considered unsafe for baby.


Who can I talk to if I have questions about usage of Promethazine With Codeine | Promethazine Hydrochloride And Codeine Phosphate Syrup in breastfeeding?

US
National Womens Health and Breastfeeding Helpline: 800-994-9662 (TDD 888-220-5446) 9 a.m. and 6 p.m. ET, Monday through Friday

UK
National Breastfeeding Helpline: 0300-100-0212 9.30am to 9.30pm, daily
Association of Breastfeeding Mothers: 0300-330-5453
La Leche League: 0345-120-2918
The Breastfeeding Network supporter line in Bengali and Sylheti: 0300-456-2421
National Childbirth Trust (NCT): 0300-330-0700

Australia
National Breastfeeding Helpline: 1800-686-268 24 hours a day, 7 days a week

Canada
Telehealth Ontario for breastfeeding: 1-866-797-0000 24 hours a day, 7 days a week

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