Appendix 7. Pain management in pregnant or lactating women


Analgesics
Pregnancy
Breastfeeding
0-5 monthsFrom 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 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)

possibleThe 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

possibleThe 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.