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Codeine in breastfeeding — GPhC CRA MCQ

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ModerateCNS TherapeuticsCodeine in breastfeedingGPhC CRA

A 34-year-old woman breastfeeding a 3-week-old baby asks for codeine for dental pain after paracetamol has not helped. The baby was born at term and is well. What is the most appropriate alternative?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Avoid codeine and refer for suitable analgesia advice such as ibuprofen if appropriate

Codeine is generally avoided during breastfeeding because variable metabolism can expose the infant to morphine and cause serious toxicity. Ibuprofen and paracetamol are commonly preferred if appropriate for the patient, with dental assessment for the cause of pain. Timing codeine around feeds does not remove risk. Stopping breastfeeding should not be suggested casually without clinical need and support.

Reference: BNF; NICE CKS Analgesia