In: Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006.


The excretion of tramadol into milk is low and even lower amounts of the active metabolite, O-desmethyltramadol, are excreted. With usual maternal dosage, the amount excreted into breastmilk is much less than the dose that has been given to newborn infants for analgesia and is unlikely to adversely affect nursing infants.[1] Studies in breastfed newborn infants found no adverse effects attributable to tramadol. However, a death occurred in the 8-month-old breastfed infant of a woman addicted to tramadol, but breastfeeding exposure alone might not have accounted for the death. Maternal use of oral opioids during breastfeeding can cause infant drowsiness, which may progress to rare but severe central nervous system depression. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. If tramadol is required by the mother of a newborn, it is not a reason to discontinue breastfeeding; however, once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of oral tramadol to 2 to 3 days at a low dosage with close infant monitoring. The U.S. Food and Drug Administration and the manufacturer recommend against the use of tramadol during breastfeeding.[2] If tramadol is used, monitor infants for increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties or limpness, and contact a physician immediately if any of these occur.

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