RETRACTED: Maternal Codeine is Not Safe for all Breast-Fed Infants

Abstract

Answer When the mother is an ultra-rapid metabolizer of cytochrome 2D6, she produces much more morphine than most people. Considering limiting codeine administration to no more than a few days and staying aware of potential opioid toxicities are two management points discussed in this article. Codeine is commonly used in the postpartum period for pain associated with episiotomy and caesarean section. As most new mothers initiate breast-feeding, the safety of codeine itself, and its pharmacologically active metabolite, morphine, are of primary concern in breast-fed infants. The American Academy of Pediatrics and major authoritative texts list codeine as compatible with breast-feeding, despite the lack of sufficient published data to support this recommendation. To illustrate the need for further assessment of codeine/morphine transfer into breast milk, we use the case of a full-term, breast-fed infant who died with a picture consistent with morphine overdose. 3 The pharmacogenetic assessment of maternal drug biotransformation was consistent with an enhanced formation of the pharmacologically active opioid, morphine.