Health - Is paracetamol dangerous & can you suggest a non-toxic alternative?

[Alfa]

Is taking paracetamol daily dangerous?


Dose is 1000mg once or twice daily.

The reason I am asking is that I have a friend who is pregnant and suffering from RLS (Restless Legs Syndrome) to the point where she is extremely sleep deprived unless she takes 2 panadine once or twice a night. Each pill contains 500mg paracetamol and 8mg codeine. She does not care for the paracetamol but the small amount of codeine is enough to settle her symptoms and give her some rest/sleep/peace at night.

Previously she was on a bunch of prescribed medication for her RLS but she had to stop taking it all when she found out she was pregnant as none of it was safe to take during pregnancy. Fortunately her RLS symptoms settled down but now as she is the final stage of pregnancy it has flared back up and she is finding it difficult to cope without some type of medication. The past 4 nights she has taken 2-4 panadine tablets at night, but she thought this treatment would only be safe for her baby and her liver for a few nights.

Yesterday she had an appointment with her OB who informed her that she could take panadine every night till the end of her pregnancy and that it is perfectly safe. I find this hard to believe so thought I would come to the experts here for some advice. She may be able to get a prescription for low dose codeine, but her doctor has always been reluctant to prescribe her anything that has addictive potential due to her addiction history. She would prefer to put as little in her body as possible, and as the paracetamol does not help her RLS she would like to feel confident that it is totally safe to take daily, both for her and baby. If not she will definitely be pushing for prescription for something safe, or taking the alternative and going mad from sleep deprivation!

If anyone has some factual evidence or research on daily use of paracetamol please post it below.

[dr. swim]

Someone's cat should try Kratom, works better than tylenol or motrin and relieves ALL types of pain, and isn't toxic. Just an herb.

[Nature Boy]

8mg of codeine is a very low dose. Chances are whatever relief she was experiencing on this dose before may be attributed to the placebo effect. If the symptoms are becoming more problematic, chances are that the low dose may not be sufficient to get her through. As for the risks involved with panadine use during pregnancy, I'm not sure. I would probably go with a professional's recommendation. Opiates are not thought to effect children in the womb directly. The real risk only becomes apparent if the user allows their body to fall into decline as a result of abuse or addiction. More the peripheral effects rather than the direct effects of the drug.

By all means, I am not an authority when it comes to this and may the door be left wide open for other opinions. Ultimately however, I don't think the risks are that great as long as she sticks to medical recommendations.

[Alfa]

Kratom for a pregnant person is not a sound idea. Please try to think of non-psychoactive drugs.

So the first question is:
What is the best non-psychoactive painkiller, with low toxicity that you would recommend?

As far as paracetamol, this is pretty hepatoxic, which means toxic to the liver. It would be good to back up that claim with facts and show the doc why paracetamol is a bad idea.
So the second question is:
Can you come up with studies or references, that prove paracetamol is dangerous with daily use?

[dark12]

At the dosages she is taking, there doesn't seem to be any major concern. Either way, have your friend evaluate her lifestyle to make sure she is not using tobacco, alcohol, or too much caffeine. Some evidence shows links between Restless Leg Syndrome and deficiencies in magnesium, folate, and iron. She can also try taking a comfortably hot bath before bed time.

According to http://www.wellsphere.com/pregnancy-...regnancy/34206

Ideally, you should avoid taking medicines while you're pregnant, particularly during the first three months of pregnancy. Often, mild conditions, such as colds and minor aches and pains, do not require treatment with medicines.

If you feel that you need to take medicines while you're pregnant, always talk to your midwife or doctor first. You can also get advice from your local pharmacy.

If you're pregnant, and you require medication for short-term pain relief, or to reduce a high temperature, acetaminophen is recommended . As with any medicine taken during pregnancy, acetaminophen should be taken at the lowest effective dose, for the shortest possible time.

Paracetamol has been used routinely during all stages of pregnancy to reduce high temperatures and for pain relief. Overall, there seems to be no clear evidence of harmful effects on the baby.

If the recommended dose of acetaminophen doesn't control your symptoms, or if you're often in pain, speak to your midwife or doctor for further advice. Depending on the cause, other medication may be recommended to help you.

The following site offers a good deal of information regarding this topic.
http://www.ehow.com/about_4564720_ac...pregnancy.html

Acetaminophen should be taken in the recommended dosage of 325-650 mg every four to six hours and not to exceed more than 4 grams in a 24 hour period. It should only be taken for up to 3 days for fever or up to ten days for pain under the guidance of a doctor. It is safest to use during the first and second trimesters of pregnancy.

Another tid bit:

Some pregnant women experience RLS, especially in their last trimester. For most of these women, symptoms usually disappear within 4 weeks after delivery.

http://www.ninds.nih.gov/disorders/r...tless_legs.htm

Reputation Comments on this post:

Wow, fantastic information here, thank you for posting this.

[TommyRowe]

From all that I know about the drug, although not 100% safe it is relatively safe during pregnancy. It is Hepatoxic in higher doses but at recommended doses it is safe to the liver. No conclusive studies, at least none that I have seen, have shown any damage done to the fetus when taken at recommended doses for any length throughout the pregnancy. Admittedly, her OB/GYN probably knows more about it (being that he/she is a physician) however it might be worth it to consult a pediatrician to find out if there is any complications that have shown in the neo-natal stage of children born to parents taking the drug... I know The Lancet published a article on theroputic doses, however I have never read the article and I dont know if it speaks to pregnancy or not. It might be worth looking up. Ive heard that long term use can lead to pulmonary disorders, including asthma, but I dont have any evidence at the moment to back that up.

Doses of over 2000 mg per day have reported side effects that include liver damage. Keep it as low as possible. Dont go over the recommended dosage as prescribed. How much longer is she in pregnancy? Sounds like, by the way you described it, she is at least in the final trimester. If thats true, I would say she is safe to take it AT RECOMMENDED DOSES and no more. Less if possible. Only take in when absolutely needed but any substantial risk that may be associated with it would cause more issues for her than the fetus. Play it safe. Get a second oppinion, preferably from a pediatrician or even someone who was done a rotation at length in a NICU or a Neo-Natal unit to find out if they have ever seen any symptomatic problems relating to the drug and the mother taking it.

Ill keep my eyes open for articles and tomorrow I will consult a couple physician friends of mine to see what the majority rule is.

EDIT: Thinking about it... 2000 mg a day is a bit high, for anyone, for extended use. Its fine for awhile but this drug in particular is extremely dangerous to the liver. Although no pregnancy complications should arise, she should be concerned about her potential state of health also... dont use this drug as a long term treatment. Consult a doctor once the pregnancy is over to find better medication for the RLS... which it sounds like she was on before the pregnancy. Most likely something in the *zepam family, some sort of opiate...

Reputation Comments on this post:

	Thanks for this info. Look forward to any more info you can provide on this.
	inaccurate info

[pinksox]

There haven't been any decent studies of codeine use in pregnant woman. Current guidelines state that acetaminophen/paracetamol and codeine preparation should only be used in pregnancy IF the benefits of doing such outweigh the risks of taking the medication. It is categorized as A/B for use in pregnant women. There doesn't seem to be any truly frightening risks for low-to-moderate usage that would outweigh the benefits of getting adequate sleep.

The main concern would be the potential for the newborn to have respiratory depression secondary to use of the drug as it easily crosses the placental barrier...as do all narcotic analgesics. The other thing to really put some thought into is because the drug crosses the placental barrier is that each time she doses herself, she's also doses the unborn child. This means the infant will suffer from withdrawal symptoms after birth. Codeine is also present in breast milk.

While Obstetrics isn't SWIM's speciality, if SWIM was in this position, SWIM would strongly consider a last month taper to avoid any potential delivery complications and, moreso, to help ease the newborn through withdrawal. Although SWIY's friend should not be too surprised if SWIbaby gets a bit cranky and more active while still on the inside during this time...this could make nights really "interesting."

Acetaminophen is generally considered safe for use during pregnancy. SWIY's friend seems to be well within the 65mg/kg or 4g/24hour guideline. Of course, less is always better in pregnancy...as the liver is already working overtime to support both the mother and the child. And pushing the limits longterm isn't wise either.

SWIM would definitely avoid the use of any medications that are absolutely contraindicated, Category C (like benzos) in pregnancy...or any other "herbal" substances that no one has any idea of how they might affect either pregnancy or the unborn, developing fetus.

So, from what SWIM knows, and what SWIM has just read to double check upon, SWIY's friend should be alright to continue with the paracetamol/codeine as the OB said. SWIM does think a slow taper the last month would be prudent, if possible. And that's mostly to help the SWIbaby ease through a withdrawal.

Reputation Comments on this post:

Thanks for posting this, the withdrawal is a very important point to be considered.

[Ilsa]

paracetamol can be very problematic in pregnancy if not taken under careful supervision of an obstetrician and is very commonly the cause of overdose: http://www.medscape.com/viewarticle/518631_1

sorry, the above link is inaccesible unless you can log on through a subscribing institution: here's the relevant text:

Abstract

Acetaminophen (APAP) is the most common drug overdose in pregnancy. Available data regarding APAP overdose in pregnancy is limited to case reports and a small prospective case series. APAP has been demonstrated to cross the placenta and in toxic doses may harm the fetal and maternal hepatocytes. Fetal hepatocytes metabolize APAP into both active and toxic metabolites. These toxic metabolites may cause fetal hepatic necrosis. N-acetylcysteine (NAC) has also been demonstrated to cross the placenta and may bind toxic metabolites in both the mother and the fetus. Limited data suggest that the majority of morbidity and mortality from APAP overdose can be averted by initiation of NAC within the first 16 hours of ingestion and possibly even later. NAC may be safely administered during pregnancy and should be initiated early after APAP overdosage. The literature was reviewed through the use of OvidMEDLlNE® database, encompassing 1966 to the present. Searches were conducted using the key words acetaminophen, paracetamol, N-acetylcysteine, overdose, and hepatotoxicity. The search was further refined by selecting articles that contained these search words together with the key word pregnancy. Only English language papers were reviewed. Articles were selected on the basis of relevance to the topic. Pertinent citations found in the selected articles were also reviewed.

Introduction

Acetaminophen (APAP), known as paracetamol outside of America, is one of the most widely used over-the-counter medications.[1-3] and has become the most commonly recommended analgesic during pregnancy.[4]

In 1966, the first clinical evidence of the toxicity of APAP appeared in reports of three apparent suicide attempts, two of which were successful as the result of large overdoses.[5,6] The United States did not have its first published report of suicidal overdose until 1971.[7] Since that time, APAP has become the most common drug involved in suicidal overdose and fulminant hepatic failure in the United States.[8,9]

The first reports of APAP overdose in pregnancy resulting in fetal demise were not published until the early 1980s.[10-13] APAP appears to freely cross the placenta[10,14,15] and is in turn metabolized by fetal hepatocytes. Maternal absorption and metabolism of APAP are not affected by pregnancy,[16] and fetal metabolism of APAP occurs.[12,17] Hepatic necrosis may occur in the fetus after maternal overdose if proper treatment is delayed or not given.[18] Therapy for APAP toxicity consists of N-acetylcysteine (NAC). Based on case reports and limited data, NAC appears to be effective also for the treatment of acetaminophen overdose during pregnancy. NAC crosses the placenta and may provide hepatoprotection to the fetus by binding toxic metabolites within the fetal liver.[18,19]


i'll make a note to myself to get the whole thing and upload it to the file archive in pdf form when i'm on campus later today/tomorrow.

here is a linnk to a scientific study of paracetamol hepatotoxicity and poisoning with apap (same thing). sorry alfa, tried to upload the pdf but it wouldn't take.



here's a link to a paper specifically on treating pregnant women with RLS. folate deficiency is mentioned as a potential cause, and folateis a safe and recommended supplement for pregnant women. iron deficiency is another potential factor, but iron levels should be evaluated by her obstetrician before any supplement regimen is started. gentle stretching and massage may help mitigate the symptoms also.

on the warning side: benzodiazepines have been correlated with increased incidence of stillbirths and defects--not safe. opioids are correlated with low birth wieght, and methadone specifically carries an increased risk of sudden infant death syndrome (sids), and clonidine, eszopiclone, gabapentin and zolpidem have not been adequately studied in pregnant women. gabapentin causes fetotoxicity in rodent models.

Reputation Comments on this post:

Thanks for this research, much appreciated. The first link requires a log on though so could you please post the conten...

[Richard_smoker]

the answer is always going to tylenol for non-severe pain in pregancy.

But, for 100% safety during any pregnancy, OTC drugs, ALL HERBS, and prescription drugs should be reduced to an absolute minimum (BY THE DOCTOR!!!), but that's being a little paranoid and certainly not the standard of care in the US and Europe.

So, just to say it, i must say that the BEST therapy for 0% risk is to try lying down during the day, raising feet up on pillows, bedrest, etc.

Next, Tylenol at non-toxic doses is the ideal medicine during pregnancy.

herbs are NEVER indicated.

narcotics (including codeine) are ok if they can't be otherwise avoided---although there's a SLIGHT risk for delivering an opiate-addicted newborn, there is a common protocol for weaning neonates off narcotics with relative ease and minimal risk to the baby.

here's something to read on the topic:

Acetaminophen:

During pregnancy, acetaminophen is the most widely recommended analgesic medication. Acetaminophen is pregnancy category B during all three trimesters, making it the pain reliever of choice for pregnant patients.8 Acetaminophen does appear to cross the placenta, but three studies that involved over 10,000 newborn infants have shown no increased risk of malformations in newborns exposed to acetaminophen in the first trimester. 9 One small, retrospective study showed a slightly higher incidence of gastroschisis (a birth defect resulting in bowel protrusion near the umbilical cord) in newborns who had been exposed to the drug. The risk of gastroschisis in the infant was higher in mothers who had taken acetaminophen in conjunction with pseudoephedrine.10 Some published case reports have cited acetaminophen exposure as the possible cause for adverse effects, including one case of fatal kidney disease, but these reports are rare.9

Overall, acetaminophen is used extensively during pregnancy, and few adverse effects have been reported. Patients can be advised to take 325 to 1,000 mg every four to six hours as needed (maximum of 4,000 mg/day). Pregnant patients should be instructed to use the smallest effective dose of the medication. If the medication is ineffective, or required use is more than 10 days, the patient should be referred to her physician. Other pregnant women who should consult a physician before starting self-treatment are those with renal or hepatic dysfunction, a high-risk pregnancy, a complaint of headache in the third trimester (a possible sign of increased blood pressure and eclampsia), any pain rated higher than 6 on a scale of 1 through 10, presence of fever or other signs of infection, or pain associated with any type of trauma.11 Nonpharmacologic recommendations can be made according to the type of pain. For example, a patient complaining of headache should try resting and lying down in a dark, quiet room.

NSAIDS: Ibuprophen, naproxen, etc.

Nonsteroidal anti-inflammatory drugs (NSAIDs) that are available without a prescription include ibuprofen, naproxen, and ketoprofen. All three are pregnancy category B in the first and second trimester, and category D in the third trimester. The most studied NSAID in pregnancy is the prescription product indomethacin. Similar to the OTC products, indomethacin is also a pregnancy category B in the first trimester and D in the third trimester. The data for indomethacin could be applied to the entire class of NSAIDs, as studies for other drugs in this class are lacking.8 Compared to acetaminophen, NSAIDs have been linked with an increased risk of gastroschisis at a slightly higher rate.10 In addition, all NSAIDs used near term are associated with oligohydramnios (a low level of amniotic fluid), a premature closure of the ductus arteriosus, and inhibition of labor.9 Unfortunately, complications can also result in the newborn, such as pulmonary hypertension, fetal nephrotoxicity, and periventricular hemorrhage. 8

Generally, NSAIDs should not be used during pregnancy without approval from the patient's physician. However, when patients require self-treatment with NSAIDs, appropriate doses can be recommended: 200 to 400 mg of ibuprofen every four to six hours (maximum 1,200 mg/day); 220 mg of naproxen every eight to 12 hours (maximum 660 mg/day); and 12.5 mg of ketoprofen every six to eight hours, repeating the initial dose after one hour if no effect (maximum 75 mg/day).11

Whenever possible, the smallest effective dose should be used. The patient should be screened and referred to her physician when appropriate. Appropriate referrals include, but are not limited to, the criteria mentioned for acetaminophen, a history of gastrointestinal ulceration, blood pressure problems, and a history of NSAID-sensitive asthma. Pregnant patients should not take NSAIDs for longer than 48 hours without contacting their physician.

Salicylates

Aspirin is a pregnancy category C in doses less than 150 mg daily and a category D in standard doses in all three trimesters.9 Salicylates have been associated with increased mortality, neonatal hemorrhage, decreased birth weight, prolonged gestation and labor, and possible birth defects. A pregnant patient should never take aspirin without the approval and guidance of her physician.

http://www.uspharmacist.com/content/...icles/c/11693/

OK...after all that, i must edit one thing i said. I just read Ilsa's post and she's correct about methadone and narcotics. But pregnancy is one of those things that is SUCH a liability for lawsuits and pissing people off, etc, that frequently you will see or hear advice against tylenol or narcotics. But in general, they're both actually quite safe...just discuss anything with the doctor before trying it out, and make sure the dr discusses the spectrum of risks and benefits---because there's ALWAYS a list of potential risks (usually able to be given in percentages, incidence, prevalence, or rounded-figures). And the truth is that she shouldn't be afraid to ask for this info. the doctor will know the answer already. he's just being lazy by not explaining himself. -DICK

Reputation Comments on this post:

	Thanks for this valuable information.
	informative post

[Ilsa]

here are the various names for the chemical structure commonly called acetamenophin/paracetamol/apap--the chemical structure all are identical, so it's safe to say that they are all one and the same.

[Richard_smoker]

1 more comment about all the advice given on this forum:

1. ANY kind of neuromodulator (like anti-seizure drugs, RLS-drugs, and benzos) are to be avoided IF POSSIBLE--i.e. if there's no risk of the mother having seizures during pregnancy or any other significant health risk--so, in that ONE limited setting, it is advised that moms should stay on their anti-convulsant meds as prescribed, even dilantin (phenytoin) which probably has the worst teratogenicity of all.

[Jatelka]

As long as the dose is within the recommended limits and she takes no other drugs (or alcohol) that are metabolised by the liver, I would say that paracetamol is extremely safe in this situation, and that is what I would advise others in her position. There is no evidence that daily use (within usual dose range) is harmful

Agree, she needs to ensure she is not iron deficient (and if she is, that needs to be corrected). Iron supplements are also safe in pregnancy

Reputation Comments on this post:

Thanks for adding your thoughts on this, your opinion is much appreciated.

[chibi curmudgeon]

Originally Posted by Richard_smoker

During pregnancy, acetaminophen is the most widely recommended analgesic medication. Acetaminophen is pregnancy category B during all three trimesters, making it the pain reliever of choice for pregnant patients.

This is what I've heard as well.

However, I've never heard of APAP for RLS. But if it works, and it's taken properly, it's pretty harmless.

[rhudson]

Originally Posted by Alfa

Is taking paracetamol daily dangerous?


Dose is 1000mg once or twice daily.

The reason I am asking is that I have a friend who is pregnant and suffering from RLS (Restless Legs Syndrome) to the point where she is extremely sleep deprived unless she takes 2 panadine once or twice a night. Each pill contains 500mg paracetamol and 8mg codeine. She does not care for the paracetamol but the small amount of codeine is enough to settle her symptoms and give her some rest/sleep/peace at night.

Previously she was on a bunch of prescribed medication for her RLS but she had to stop taking it all when she found out she was pregnant as none of it was safe to take during pregnancy. Fortunately her RLS symptoms settled down but now as she is the final stage of pregnancy it has flared back up and she is finding it difficult to cope without some type of medication. The past 4 nights she has taken 2-4 panadine tablets at night, but she thought this treatment would only be safe for her baby and her liver for a few nights.

Yesterday she had an appointment with her OB who informed her that she could take panadine every night till the end of her pregnancy and that it is perfectly safe. I find this hard to believe so thought I would come to the experts here for some advice. She may be able to get a prescription for low dose codeine, but her doctor has always been reluctant to prescribe her anything that has addictive potential due to her addiction history. She would prefer to put as little in her body as possible, and as the paracetamol does not help her RLS she would like to feel confident that it is totally safe to take daily, both for her and baby. If not she will definitely be pushing for prescription for something safe, or taking the alternative and going mad from sleep deprivation!

If anyone has some factual evidence or research on daily use of paracetamol please post it below.

2000 mg/day is not a life-threatening dose of APAP for anyone without liver problems. It gets dangerous around the 10 g/day range. Chronic use is probably not a great idea but it's not going to cause acute liver problems so this is probably pretty safe right now especially compared to narcotics.

[pinksox]

However, I've never heard of APAP for RLS. But if it works, and it's taken properly, it's pretty harmless.

SWIM believes it's the codeine, moreso than the APAP, that's helping her with the RLS...or at least relaxing her enough to get some rest. SWIM hasn't found that any current RLS meds are recommended during pregnancy.

[lostinla]

Hey there I sent a message to you Alfa but with all of these other posts, I did read,, and it's FINE. That dose, that particular combo of apap/codiene will not harm her or the baby. I just called my ob to make sure and an OB anaesthesiologist as well- of course they said 'these poor pregnant moms being fed all this stuff and they do so well trying to do the best job they can to protect the little one-bravo-but it's sad for them to have to be so fearful with all of this stuff that they are told they can't do/take/etc'.. These folks are conservative too so I hope she has gotten a little peace of mind with this and her body will protect that baby no matter what, it's a miracle how that happens, she's in the homestretch so lets hope she can get some rest before 'show time'... Best of luck. I doubt you need more 'studies' posted here, looks like all pitched in. It is vital for her to get sleep, many ob gyns will let pregnant moms take 5 mg of diazepam when needed as sleep and relaxation are vital and the baby will (not be affected) feel less 'stress' from the positive physiological well being of the mom

Reputation Comments on this post:

Thanks for sharing this, hit the nail on the head for me.

[chibi curmudgeon]

Originally Posted by pinksox

SWIM believes it's the codeine, moreso than the APAP, that's helping her with the RLS...or at least relaxing her enough to get some rest. SWIM hasn't found that any current RLS meds are recommended during pregnancy.

Ah, my bad, I read the OP wrong.

See, codeine isn't recommended during pregnancy either, and there have been infants who've died from breastfeeding moms taking codeine. (Codeine is a prodrug of morphine, so except for dosage and potency, there's not much difference.)

8 mg is a pretty small dose of codeine, so I'm not surprised an adult woman needs 2-4 tabs. I think this is getting into a risk-benefit analysis, though, because if codeine is really the ONLY thing that works, the ONLY way this woman can sleep, I'm not an ob/gyn but I'm guessing it's probably safer for a pregnant woman to get some sleep with codeine than to get no sleep without it.

So basically, the paracetamol isn't a problem as much as the codeine. Has this woman tried everything else already?

[deltakappamuMD]

I am not an OB but I am an MD. I would suggest that the original poster take no advice from this forum and only be advised by her OB. Not that I'm saying things said here are wrong...it's just such a high stakes game everyone is playing here. On the whole...acetaminophen is safe in preg. Codeine is not considered safe for the fetus however her OB has weighed the risks/benefits and will best be prepared to handle a minorly "addicted" fetus if one were to be delivered (which would be minimal given that dose). Acetaminophen is hepatotoxic at doses greater than 4g (and no less unless mixed ie ETOH or other hepatically eliminated drugs) and it can also "tax" the liver when taken at lower doses for multiple days in a row. It doesn't really affect the fetus when used at low doses intermittently...sometimes even daily. Codeine affects the baby only in terms of it's mu activity. Good luck with the pregnancy and of course none of this info is a subsitute for your own doctor's advice blah blah.

Reputation Comments on this post:

Thanks for the advice.

[Ilsa]

^^i'd like to point out that several people on this thread have said that she should see her doctor before implementing any drastic changes. please read the whole thread before simply dismissing the information as a whole.

[deltakappamuMD]

Originally Posted by ilsa

^^i'd like to point out that several people on this thread have said that she should see her doctor before implementing any drastic changes. please read the whole thread before simply dismissing the information as a whole.

i understand her point of questioning her md...but the point i am making is that if her obgyn doesn't know the changes she has made...she isn't going to know how to handle the baby when delivered. A doctor needs to know if they are dealing with a high risk preg before the delivery so they can wean the fetus if needed or deal with the expected complications. This is not from the info given at the complicated stage but if she went to taking many more codeine tabs than prescribed it could quickly become one.

[Rainbowzz]

Originally Posted by chibi curmudgeon

Ah, my bad, I read the OP wrong.

See, codeine isn't recommended during pregnancy either, and there have been infants who've died from breastfeeding moms taking codeine. (Codeine is a prodrug of morphine, so except for dosage and potency, there's not much difference.)

8 mg is a pretty small dose of codeine, so I'm not surprised an adult woman needs 2-4 tabs. I think this is getting into a risk-benefit analysis, though, because if codeine is really the ONLY thing that works, the ONLY way this woman can sleep, I'm not an ob/gyn but I'm guessing it's probably safer for a pregnant woman to get some sleep with codeine than to get no sleep without it.

So basically, the paracetamol isn't a problem as much as the codeine. Has this woman tried everything else already?

I wanted to address something here. The codeine and breastfeeding thing is actually due to a specific reason:

QUESTION Recently a newborn died from morphine poisoning when his mother used codeine while breastfeeding. Many patients receive codeine for postlabour pain. Is it safe to prescribe codeine for nursing mothers?
ANSWER  When a mother is an ultrarapid metabolizer of cytochrome P450 2D6, she produces much more morphine when taking codeine than most people do. In this situation, newborns might be exposed to toxic levels of morphine when breastfeeding. Options to reduce this risk include discontinuing codeine after 2 to 3 days of use and being aware of symptoms of potential opioid toxicity in both mothers and newborns.

This is why you occasionally hear about a baby OD'ing on morphine occasionally - because of that P450 issue.

Reputation Comments on this post:

Thanks for this info.