Codeine in Pregnancy — Is It Safe?
Last reviewed: · Source: US FDA drug label database
Avoid codeine in pregnancy — it can cause neonatal opioid withdrawal syndrome and respiratory depression in the newborn if used near delivery.
Is it safe to take Codeine with Pregnancy?
Codeine should be avoided in pregnancy, particularly in the third trimester and near delivery. It crosses the placenta and can cause respiratory depression in the newborn and neonatal opioid withdrawal syndrome (NOWS). In some women, codeine is rapidly converted to morphine (ultra-rapid metabolisers), leading to dangerously high morphine levels in breast milk or, during pregnancy, in the fetus. Paracetamol is the recommended painkiller in pregnancy.
How do Codeine and Pregnancy interact?
Codeine is a prodrug converted to morphine by CYP2D6 in the liver. Morphine crosses the placenta and activates fetal opioid receptors. Prolonged fetal opioid exposure leads to physical dependence, which manifests as NOWS after birth. Third-trimester use is particularly concerning as the fetal respiratory centre is more susceptible to opioid-induced depression. The FDA warns specifically against codeine in pregnancy.
Data sourced from the US Food and Drug Administration (FDA) drug label database: FDA Drug Safety Communication: codeine and tramadol in pregnant and breastfeeding women; OpenFDA codeine drug label.
Who should be careful?
All pregnant women should avoid codeine. If strong pain relief is needed in pregnancy, discuss alternatives (paracetamol first, then obstetric pain management if severe) with your GP or midwife.
What if I've already taken Codeine and Pregnancy?
If you took co-codamol in early pregnancy before knowing you were pregnant, inform your midwife. The risk from early occasional use is lower than prolonged use near term. Do not take more codeine-containing products.
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Frequently Asked Questions
Can I take codeine when pregnant?
No. Codeine should be avoided in pregnancy, particularly in the third trimester. Paracetamol is the safe painkiller to use.
Is co-codamol safe in pregnancy?
Co-codamol contains codeine and should be avoided in pregnancy. The paracetamol component is safe, but the codeine component is not.
What strong painkiller can I take in pregnancy?
Paracetamol is the first option. If pain is severe and paracetamol is insufficient, discuss with your GP or obstetric team — they can provide appropriate pain management in pregnancy.
What is neonatal opioid withdrawal syndrome?
NOWS occurs in babies born to mothers who used opioids during pregnancy. The baby experiences withdrawal after birth, with symptoms including irritability, feeding difficulties, tremors, and vomiting. It requires medical management but is treatable.