Nursing mothers who take codeine could be turning their breast milk into a troubling brew.Nearly one-quarter of babies whose moms took the drug while breastfeeding showed signs of central nervous system depression, according to a new study.Specifically, 17 of 72 babies became sedated or experienced abnormal breathing, including one who narrowly avoided a tragic reaction, according to researchers at the Toronto-based Hospital for Sick Children. They collaborated with the University of Western Ontario."You cannot continue to give it (codeine) like candies," said Gideon Koren, lead author of the study, which was published in the journal Clinical Pharmacology & Therapeutics. "In some cases, this can be life-threatening."Although it has been known that some mothers carry multiple copies of a gene capable of converting the common pain reliever into strong concentrations of morphine, Koren said the study suggests the pharmacological phenomenon is broader than initially thought."Young babies are much more sensitive to narcotics than adults, even if you calculate per dose," Koren said, adding that any central nervous system depression is problematic.Since patients were self-selected -- the sample comprised women who called the Motherisk program at Sick Kids in Toronto for advice on the pain reliever from January of 2004 to January of 2007 -- further study is required, Koren said.Strategies to prevent overdoses include taking minimal doses, not using the drug for more than four days, closely monitoring the baby for grogginess and, in suspected cases, providing the antidote naloxone. There are other pain-relieving drugs without codeine that nursing mothers can take. Testing for the gene is considered costly and less feasible.The FDA requires manufacturers of prescription codeine to include information in drug-package insert information about the so-called ultra-rapid metabolism for patients who may unwittingly carry multiple copies of the gene.Of the 72 patients in the study, Koren said three had multiple copies of the gene.Health Canada said it is studying proposed labeling changes that better identify the potential risk to nursing children posed by the presence of codeine in breast milk, according to spokesman Paul Duchesne. Shellie Suter, spokeswoman of Janssen-Ortho Inc., which markets the drug in Canada, said the company has not yet seen a copy of the study and therefore cannot comment. It is a subsidiary of Johnson & Johnson."The safety of patients who use our products is a priority for the company," Suter wrote in a prepared statement. "TYLENOL 3 (prescription Tylenol with codeine) is a safe and effective product when used according to the approved prescribing information."(Distributed by Scripps Howard News Service, www.scrippsnews.com.)
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