The Risks Of Using Tramadol While Breastfeeding

Tramadol is a prescription pain medication similar to the opiate drug codeine, though tramadol is fully synthetic (man-made). Tramadol is commonly used as an analgesic to soothe chronic pain or severe pain following surgical procedures, similar to other opioid drugs currently in use.

In 2019, the U.S. Food and Drug Administration released a lengthy explainer detailing the potential risks involved when intravenous or oral tramadol is used by breastfeeding women.

Is Tramadol Safe To Use While Breastfeeding?

No.

The use of tramadol by certain breastfeeding women can cause serious adverse effects in breastfed infants that may include:

• excessive sleepiness
• difficulty feeding
• serious breathing problems and respiratory depression that may result in death

This risk has been cautioned against via a drug safety communication notice and stricter warnings associated with Tramadol prescriptions.

How Does Tramadol Work In The Body?

Tramadol is a prodrug to another drug known as O-desmethyltramadol (M1). This means that after tramadol enters the body it is converted in the liver to M1, its active metabolite, by a specific liver enzyme (cytochrome P450 isoenzyme 2D6, or simply CYP2D6).

Tramadol is serotonergic, which means it increases the activity of the neurotransmitters serotonin and norepinephrine in the brain and potentially improves symptoms related to mood disorders or depression.

However, M1 acts as an opioid narcotic, providing pain relief and calming activity across the central nervous system (CNS). These two effects make tramadol an effective analgesic medication in many cases.

Why Is Tramadol Unsafe To Use While Breastfeeding?

A small percentage of the population has a variant of the CYP2D6 liver enzyme that works much faster than normal, converting tramadol and increasing M1 levels in the bloodstream rapidly. These individuals are known as ultra-rapid metabolizers.

If an ultra-rapid metabolizer takes tramadol or codeine while breastfeeding, there is a chance that their body will process the drug too quickly.

This could complete the transfer of tramadol to M1 and boost M1 levels in the breast milk to the point that it could cause harm or death to their child through opioid overdose. 

Although cases are rare, these exact adverse events have been uncovered in reviews of medical literature regarding tramadol and breastfeeding mothers.

How Common Are Ultra-Rapid Metabolizers?

It varies among different population groups, with East Asians having the lowest percentage at 1-2% and some diverse populations having percentages potentially greater than 10%.  

There is no easy or convenient way to identify if you or a loved one have this variant liver enzyme, and the FDA, therefore, advises that health care professionals and impacted patients discuss their use of pain medicines and consider alternatives to codeine and tramadol.

What Are The Symptoms Of Opioid Overdose In Infants?

While ultra-rapid metabolizers may experience greater, though shorter-lived, analgesia from typical opioid doses, neonates/babies will display overdose symptoms first due to their smaller size and sensitivity. 

Symptoms of opioid overdose in infants may include:

• unusual drowsiness (breastfeed infants should eat every 2-3 hours, sleeping no more than 4 hours at a time)
• difficulty breastfeeding/poor latching
• shallow, labored, or stopped breathing
• limpness

Even minor opioid exposure in breast milk is known to cause gastrointestinal dysfunction and constipation. It can also have other developmental effects related to reward, stress responses, hormone function, and aggression.

Accordingly, while limited opioid use is tolerated by the majority of breastfeeding women without major side-effects, it’s recommended that opioid painkillers such as oxycodone, codeine, and tramadol be avoided during pregnancy or while breastfeeding.

What About Over-The-Counter Painkillers?

The FDA cautions that some over-the-counter cough/cold combination products contain codeine, which carries the same risks as tramadol. 

Always check the label of any medications for warnings about use while breastfeeding and talk to your healthcare provider before taking a new medication.

Acetaminophen (Tylenol) and ibuprofen (Advil or Motrin IB) are generally considered safe postpartum pain management options when used responsibly.

Formula and breastmilk donations are two other options available to new mothers who require treatment with opioid painkillers for one reason or another.

Treatment For Tramadol Dependence

Tramadol, despite being a relatively weak opioid drug, can still be severely habit-forming.

If you or a loved one struggles with tramadol dependence or misuse, please contact Ark Behavioral Health today and ask about our individualized treatment and recovery programs.