Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Nursing, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
J Hum Lact. 2024 Feb;40(1):113-119. doi: 10.1177/08903344231209304. Epub 2023 Nov 29.
Breastfeeding among lactating people with opioid use disorder taking buprenorphine monotherapy is generally accepted, as low concentrations of buprenorphine and metabolites in human milk have been well-established. The use of buprenorphine-naloxone for pregnant and lactating people with opioid use disorder is expanding and there is no information available regarding the concentrations of naloxone and their metabolites in human milk to recommend the use of this combination medication during lactation.
To determine the concentrations of buprenorphine and naloxone and their primary metabolites in human milk, maternal plasma, and infant plasma, among lactating buprenorphine-naloxone maintained people and their infants.
Four lactating buprenorphine-naloxone maintained people provided plasma and human milk samples on Days 2, 3, 4, 14, and 30 postpartum. Infant plasma was obtained on Day 14.
Concentrations of buprenorphine, norbuprenorphine and their glucuronide metabolites were present in maternal plasma and human milk at low concentrations, consistent with previous research in lactating buprenorphine monotherapy participants. Naloxone was not detected, or was detected at concentrations below the limit of quantification, in maternal plasma and in all except one human milk sample at Day 30. Naloxone was not detected or detected at concentrations below the limit of quantification in all infant plasma samples.
Results support the use of buprenorphine-naloxone by lactating people who meet appropriate criteria for breastfeeding.
接受丁丙诺啡单药治疗的哺乳期阿片类药物使用障碍患者母乳喂养通常是可以接受的，因为人乳中丁丙诺啡及其代谢物的浓度较低已得到充分证实。丁丙诺啡-纳洛酮在患有阿片类药物使用障碍的孕妇和哺乳期妇女中的使用正在扩大，但尚无关于人乳中纳洛酮及其代谢物浓度的信息可用于推荐在哺乳期使用这种联合药物。
确定哺乳期丁丙诺啡-纳洛酮维持者及其婴儿的人乳、母体血浆和婴儿血浆中丁丙诺啡和纳洛酮及其主要代谢物的浓度。
4 名哺乳期丁丙诺啡-纳洛酮维持者在产后第 2、3、4、14 和 30 天提供了血浆和人乳样本。在第 14 天获得了婴儿的血浆样本。
丁丙诺啡、去甲丁丙诺啡及其葡萄糖醛酸代谢物在母体血浆和人乳中的浓度均较低，与哺乳期丁丙诺啡单药治疗参与者的先前研究一致。纳洛酮在母体血浆中和除 1 个人乳样本在第 30 天外的所有样本中均未检测到，或检测到的浓度低于定量下限。纳洛酮在所有婴儿血浆样本中均未检测到或检测到低于定量下限的浓度。
结果支持符合适当母乳喂养标准的哺乳期人群使用丁丙诺啡-纳洛酮。
