The Basics
What is Cocaine?
Predominantly used for nasal and lacrimal duct surgery.
Brand names for Cocaine
Cocaine
How Cocaine is classified
Anesthetics – Local, Dopamine Uptake Inhibitors, Street Drugs, Vasoconstrictor Agents
Cocaine During Pregnancy
Cocaine pregnancy category
Category CNote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Cocaine while pregnant
Teratogenic Effects-Pregnancy Category C: Animal reproduction studies have not been conducted with cocaine (cocaine hydrochloride topical solution) . It is also not known whether cocaine (cocaine hydrochloride topical solution) can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Cocaine (cocaine hydrochloride topical solution) should be given to a pregnant woman only if needed.
Taking Cocaine While Breastfeeding
What are recommendations for lactation if you're taking Cocaine?
No data are available on the medical use of cocaine in nursing mothers. However, because of its chemical nature, high concentrations of cocaine are expected in milk.[1][2] Cocaine and its metabolites are detectable in breastmilk, although data are from random breastmilk screening of mothers who used cocaine recreationally rather than controlled studies. Cocaine breastmilk concentrations have varied over 100-fold in these reports. Newborn infants are extremely sensitive to cocaine because they have not yet developed the enzyme that inactivates it and serious adverse reactions have been reported in a newborn infant exposed to cocaine via breastmilk. Cocaine should not be used by nursing mothers or smoked (such as with crack ) by anyone in the vicinity of infants because the infants can be exposed by inhaling the smoke.[3][4] Other factors to consider are the possibility of positive urine tests in breastfed infants which might have legal implications, and the possibility of other harmful contaminants in street drugs. A breastfeeding abstinence period of 24 hours has been suggested for women who occasionally use cocaine while breastfeeding, based on the rapid elimination of cocaine by the mother.[5] Some authors have proposed that breastfeeding be discontinued only for those infants who test positive for cocaine exposure.[6] However, the Academy of Breastfeeding Medicine suggests that women who have abused cocaine generally should not breastfeed unless they have a negative maternal urine toxicology at delivery, have been abstinent for at least 90 days, are in a substance abuse treatment program and plan to continue it in the postpartum period, have the approval of their substance abuse counselor, have been engaged and compliant in their prenatal care, and have no other contraindications to breastfeeding.[7]
Maternal / infant drug levels
No data are available on the medical use of cocaine in nursing mothers. However, because of its chemical nature, high concentrations of cocaine are expected in milk.[1][2] Cocaine and its metabolites are detectable in breastmilk, although data are from random breastmilk screening of mothers who used cocaine recreationally rather than controlled studies. Cocaine breastmilk concentrations have varied over 100-fold in these reports. Newborn infants are extremely sensitive to cocaine because they have not yet developed the enzyme that inactivates it and serious adverse reactions have been reported in a newborn infant exposed to cocaine via breastmilk. Cocaine should not be used by nursing mothers or smoked (such as with crack ) by anyone in the vicinity of infants because the infants can be exposed by inhaling the smoke.[3][4] Other factors to consider are the possibility of positive urine tests in breastfed infants which might have legal implications, and the possibility of other harmful contaminants in street drugs. A breastfeeding abstinence period of 24 hours has been suggested for women who occasionally use cocaine while breastfeeding, based on the rapid elimination of cocaine by the mother.[5] Some authors have proposed that breastfeeding be discontinued only for those infants who test positive for cocaine exposure.[6] However, the Academy of Breastfeeding Medicine suggests that women who have abused cocaine generally should not breastfeed unless they have a negative maternal urine toxicology at delivery, have been abstinent for at least 90 days, are in a substance abuse treatment program and plan to continue it in the postpartum period, have the approval of their substance abuse counselor, have been engaged and compliant in their prenatal care, and have no other contraindications to breastfeeding.[7]
Possible effects of Cocaine on milk supply
Long-term cocaine use can result in chronic, low-level hyperprolactinemia.[16][17][18] The prolactin level in a mother with established lactation may not affect her ability to breastfeed.
Mothers who use cocaine initiate breastfeeding of their infants less frequently than mothers who do not use cocaine.[19][20]
Possible alternatives to Cocaine
None listed
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. Dickson PH, Lind A, Studts P et al. The routine analysis of breast milk for drugs of abuse in a clinical toxicology laboratory. J Forensic Sci. 1994;39:207-14. PMID: 8113701
2. Bailey DN. Cocaine and cocaethylene binding to human milk. Am J Clin Pathol. 1998;110:491-4. PMID: 9763035
3. Bateman DA, Heagarty MC. Passive freebase cocaine (‘crack’) inhalation by infants and toddlers. Am J Dis Child. 1989;143:25-7. PMID: 2910042
4. Heidemann SM, Goetting MG. Passive inhalation of cocaine by infants. Henry Ford Hosp Med J. 1990;38:252-4. PMID: 2086554
5. Cressman AM , Koren G, Pupco A, Kim E, Ito S, Bozzo P. Maternal cocaine use during breastfeeding. Can Fam Physician. 2012;58:1218-19. PMID: 23152457
6. Sarkar M, Djulus J, Koren G. When a cocaine-using mother wishes to breastfeed: proposed guidelines. Ther Drug Monit. 2005;27:1-2. PMID: 15665737
7. Reece-Stremtan S, Marinelli KA. ABM Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder, Revised 2015. Breastfeed Med. 2015;10:135-41. PMID: 25836677
8. Chasnoff IJ, Lewis DE, Squires L. Cocaine intoxication in a breast-fed infant. Pediatrics. 1987;80:836-8. PMID: 3684393
9. Winecker RE, Goldberger BA, Tebbett IRet al. Detection of cocaine and its metabolites in breast milk. J Forensic Sci. 2001;46:12221-3. PMID: 11569568
10. Marchei E, Escuder D, Pallas CR et al. Simultaneous analysis of frequently used licit and illicit psychoactive drugs in breast milk by liquid chromatography tandem mass spectrometry. J Pharm Biomed Anal. 2011;55:309-16. PMID: 21330091
11. D’Avila FB, Pereira AG, Salazar FR et al. Determination of cocaine/crack biomarkers in colostrum by LC-MS following protein precipitation. J Pharm Biomed Anal. 2015;103C:67-72. PMID: 25462122
12. Silveira GO, Belitsky IT, Loddi S et al. Development of a method for the determination of cocaine, cocaethylene and norcocaine in human breast milk using liquid phase microextraction and gas chromatography-mass spectrometry. Forensic Sci Int. 2016;265:22-8. PMID: 26826849
13. dos Santos RR, Nunes Paiva MJ, Veloso JC et al. Efficient extraction method using magnetic carbon nanotubes to analyze cocaine and benzoylecgonine in breast milk by GC/MS. Bioanalysis. 2017;9:1655-66. PMID: 29095043
14. Shannon M, Lacouture PG, Roa J, Woolf A. Cocaine exposure among children seen at a pediatric hospital. Pediatrics. 1989;83:337-42. PMID: 2783999
15. Chaney NE, Franke J, Wadlington WB. Cocaine convulsions in a breast-feeding baby. J Pediatr. 1988;112:134-5. PMID: 3335951
16. Mello NK, Mendelson JH. Cocaine’s effects on neuroendocrine systems: clinical and preclinical studies. Pharmacol Biochem Behav. 1997;57:571-99. PMID: 9218281
17. Elman I, Lukas SE. Effects of cortisol and cocaine on plasma prolactin and growth hormone levels in cocaine-dependent volunteers. Addict Behav. 2005;30:859-64. PMID: 15833589
18. Patkar AA, Hill KP, Sterling RC et al. Serum prolactin and response to treatment among cocaine-dependent individuals. Addict Biol. 2002;7:45-53. PMID: 11900622
19. Bauer CR, Langer JC, Shankaran S et al. Acute neonatal effects of cocaine exposure during pregnancy. Arch Pediatr Adolesc Med. 2005;159:824-34. PMID: 16143741
20. England L, Brenner R, Bhaskar B et al. Breastfeeding practices in a cohort of inner-city women: the role of contraindications. BMC Public Health. 2003;3:28. PMID: 12930560
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
