Tramadol While Breastfeeding

Painkillers are advised by most healthcare professionals to mothers after childbirth in order to manage pain in case of episiotomy, cesarean section, or post-delivery muscular pain. Tramadol is a preferred choice because of potent analgesic effect. But like most drugs, tramadol is secreted in the breast milk and substantial quantities may be delivered to the baby if it is consumed by the lactating mother for a long time.

Why should you avoid tramadol if lactating?

Tramadol has been assigned category "C" by FDA (Food and Drug Administration) since there is not enough data available to determine if tramadol is safe during lactation in humans.

FDA Class C includes drugs in which human studies is insufficient to say with precision if consumption is safe during pregnancy/lactation or not. However, animal studies indicated potential threat. FDA suggests avoiding Class C drugs unless the potential benefits are higher than potential harm.

Research indicates that tramadol is unsafe in pediatric-aged children (under 18 years) and a number of studies conducted on animal model indicate moderate to severe complications in the fetuses exposed to tramadol during in-vitro life or after- birth.

Research indicates that almost 0.12% of the entire tramadol dose (about 100 mg via intravenous mode) can be secreted in breast- milk, for a period of up to 16 hours after intake. This amount of secreted tramadol does not produce significant side-effects provided it is consumed infrequently and in low dosage. However, tramadol should be discontinued if intake is more frequent and the dosage is high.

Tramadol can produce several undesirable side effects in growing children that may range from skeletal abnormalities to growth restriction. Healthcare professionals suggest avoiding tramadol and other similar narcotic agents while breastfeeding. Moreover, babies may also develop tramadol dependence leading to withdrawal symptoms if it is abruptly stopped by the mothers. Research indicates that infants develop dependence earlier than adults.

The primary cause of toxicity/dependence in babies is immature renal and hepatic system that is incapable of excreting drug metabolites, resulting in pooling of drugs and prolonged duration of action.

Scientific recommendations for tramadol use during lactation

Kenneth F. Ilett conducted a study to assess the result of tramadol administration to infants and identified that a dose under 100 mg/ day of oral tramadol by lactating mothers for a brief period is not associated with significant side effects in babies or in mothers.

Another study conducted by Sam Salman on 75 lactating mothers revealed significant secretion of tramadol in breast milk. The author suggested that the most negative effects are produced by the active metabolites of tramadol. At an average daily consumption of 0.15 L breast milk per day, babies can have tramadol levels between 2.16 to 2.60, which are quite significant.

Recommendations for tramadol use after childbirth

For maximum safety of the newborn, it is advised by healthcare professionals to avoid tramadol if you are breastfeeding your baby, unless no other pain relief option is available. In all these situations:

• If tramadol is necessary for pain relief, you can stop breastfeeding while you are on a tramadol regimen.
• Since tramadol metabolic products stay in your system for a few days, healthcare professionals suggest resuming breastfeeding at least 1 week after discontinuing tramadol.

Consult your healthcare professional regarding other safe alternative methods of pain management and maintain high hydration to clear tramadol from your system as early as possible.