Appendix 7. Pain management in pregnant or lactating women

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    Analgesics
    Pregnancy
    Breastfeeding
    0-5 months From 6th month

    Level 1

    paracetamol PO
    1 g every 6 to 8 hours (max. 4 g daily)

    paracetamol IV
    < 50 kg: 15 mg/kg every 6 hours (max. 60 mg/kg daily)
    ≥ 50 kg: 1 g every 6 hours (max. 4 g daily)

    first choice

    first choice

    first choice

    ibuprofen PO
    200 to 400 mg every 6 to 8 hours (max. 1200 mg daily)

    avoid

    contra-indicated

    possible

    Treatment must be as short as possible (≤ 5 days).
    Respect contra-indications.

    acetylsalicylic acid (aspirin) PO

    avoid

    contra-indicated

    avoid

    Level 2

    codeine PO
    30 to 60 mg every 4 to 6 hours (max. 240 mg daily)

    possible

    The neonate may develop withdrawal symptoms, respiratory depression and drowsiness in the event of prolonged administration of large doses at the end of the third trimester. Closely monitor the neonate.

    Use with caution, for a short period (2-3 days), at the lowest effective dose.
    Monitor the mother and the neonate: in the event of excessive drowsiness, stop treatment.

    tramadol PO
    50 to 100 mg every 4 to 6 hours (max. 400 mg daily)

    tramadol IM, slow IV or infusion
    50 to 100 mg every 4 to 6 hours (max. 600 mg daily)

    possible The neonate may develop drowsiness when the mother receives tramadol at the end of the third trimester and during breast-feeding. Administer with caution, for a short period, at the lowest effective dose, and monitor the neonate.
    Level 3

    morphine PO immediate release (MIR)
    10 mg every 4 hours, to be ajusted in relation to pain intensity

    morphine PO sustained release (MSR)
    The daily dose is determined during the initial treatment with immediate release morphine (MIR).
    If treatment is initiated directly with MSR: 30 mg every 12 hours, to be ajusted in relation to pain intensity

    morphine SC, IM
    0.1 to 0.2 mg/kg every 4 hours

    morphine IV
    0.1 mg/kg administered in fractionated doses (0.05 mg/kg every 10 minutes) every 4 hours if necessary

    possible The neonate may develop withdrawal symptoms, respiratory depression and drowsiness when the mother receives morphine at the end of the third trimester and during breast-feeding.
    Administer with caution, for a short period, at the lowest effective dose, and monitor the neonate.