Trade names: Darvocet N, Propacet, Darvon

Lactation Risk Category: L2 – Safer (see below)

Propoxyphene is a mild narcotic analgesic. The amount secreted into breastmilk is extremely low – too low to produce effects in the infant. So far, there are no reports of adverse effects in an infant.

MEDICATIONS WHILE BREASTFEEDING:

One of the best sources of information regarding the safety of medications while breastfeeding is a book written by Dr Thomas Hale, called “Medications and Mother’s Milk” (Pharmasoft publishing). It is updated yearly, and provides the latest studies that have been conducted on a wide variety of medications, including herbals and homeopathy. I keep a copy of this book in my office, and it is one of my most-used references. Any lactation consultant will have this book, and a good maternity ward should have it, too. Medications are divided into five categories depending on their level of safety in a breastfeeding mother. These categories range from L1 (safest) to L5 (contraindicated).

L1 – Safest – Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote or the product is not orally bioavailable in an infant.

L2 – Safer – Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effect in the infant. And/or the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.

L3 – Moderately Safe – There are no controlled studies in breastfeeding women; however, the risk of untoward effects to a breastfeeding infant is possible or controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant.

L4 – Possibly Hazardous – There is positive evidence of risk to a breastfed infant or to breastmilk production but the benefits from use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

L5 – Contraindicated (meaning inadvisable) – Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.