Breast milk oxycodone concentrations in mothers given oxycodone for post-Caesarean delivery pain management.

Autor: Pesonen A; School of Pharmacy, University of Eastern Finland, Kuopio, Finland., Hakomäki H; School of Pharmacy, University of Eastern Finland, Kuopio, Finland., Kokki H; School of Medicine, University of Eastern Finland, Kuopio, Finland., Ranta VP; School of Pharmacy, University of Eastern Finland, Kuopio, Finland., Rinne V; Admescope (Symeres Finland oy), Oulu, Finland., Kokki M; Department of Anesthesia and Intensive Care, Kuopio University Hospital, Kuopio, Finland.
Jazyk: angličtina
Zdroj: British journal of clinical pharmacology [Br J Clin Pharmacol] 2024 Apr; Vol. 90 (4), pp. 1183-1192. Date of Electronic Publication: 2024 Feb 02.
DOI: 10.1111/bcp.16008
Abstrakt: Aims: Both effective analgesia and early breastfeeding play an important role in maternal and neonatal well-being after Caesarean delivery. We studied controlled-release oxycodone tablet treatment for postoperative pain management and determined the excretion of oxycodone into breast milk.
Methods: Controlled-release oxycodone/naloxone 10/5-mg tablets (n = 21) or controlled-release oxycodone 10-mg tablets (n = 22) were administered to mothers twice a day for the first 3 days after elective Caesarean delivery as a part of multimodal analgesia. Maternal plasma and breast milk samples were collected daily. Oxycodone, noroxycodone, oxymorphone and noroxymorphone concentrations were analysed with ultra-performance liquid chromatography-mass spectrometry. Maternal pain intensity was recorded with an 11-point Numeric Rating Scale (0-10). Neonatal oxycodone exposure was estimated by simulating five different exposure scenarios, including the highest possible exposure through breast milk.
Results: The mean oxycodone and noroxycodone milk-to-maternal plasma ratios were 3.2 and 3.0, respectively. A strong correlation was found between plasma and breast milk oxycodone (R 2  = 0.87) and noroxycodone concentrations (R 2  = 0.91). In the simulated highest neonatal exposure scenario, the neonate's maximum plasma concentration was estimated to be 5.4 ng/mL and the estimated weight-adjusted infant oxycodone dose was less than 10% of the maternal dose. Pain intensities were similarly low between the two treatment groups.
Conclusions: The oxycodone dose received from colostrum and breast milk during the first three postoperative days after Caesarean delivery is assumed safe for healthy, term neonates, but in extreme cases it is possible for the neonate to receive a dose through breast milk that may elicit opioid effects.
(© 2024 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.)
Databáze: MEDLINE
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