Last update July 10, 2023

Heroin Hydrochloride

Limited compatibility

Unsafe. Moderate/severe adverse effects. Compatible under certain circumstances. Follow-up recommended. Use safer alternative or discontinue breastfeeding from 5 to 7 T ½ . Read Commentary.

Heroin or diacetylmorphine or diamorphine is a prodrug that is metabolised to 6-monoacetylmorphine and then to morphine. It is obtained from opium poppies (Papaver somniferum). It is an opioid analgesic agent used for the relief of severe pain associated with surgical procedures, palliative care, myocardial infarction or pain in the terminally ill and for the relief of dyspnoea in acute pulmonary oedema. It is mainly used as a drug of abuse. Illicit heroin usually comes in the form of a matte white powder to which various adulterants such as cutting agents are added. Subcutaneous, intramuscular, intravenous or oral administration.

It is excreted in breast milk where it is detected in the form of morphine (Marchei 2011) and in sufficient quantity to create addiction in the breastfed infant and older child. (Eslami 2015)

Breastfeeding by heroin-addicted mothers can cause symptoms of severe respiratory distress with cyanosis, drowsiness, poor feeding or irritability in the infant (Joya 2011, vande Velde 2007), and also prevent a possible withdrawal syndrome in the breastfed infant or older child. (Eslami 2015, van de Velde 2007, Godfriend 1956)

Long-term physical and psychomotor development may be diminished (Wilson 1979). Heroin increases prolactin levels (Spagnolli 1987) and may cause galactorrhea-amenorrhea syndrome. (Pelosi 1974).

Illegal psychotropic drugs impair the mother’s ability to care for her child, endangering the life and health of both. (Eslami 2015, Joya 2011, Moretti 2000)

Medical use of heroin can be considered during lactation, in the same way as its metabolite morphine.

Its use as a drug of abuse is totally contraindicated. A waiting period of 7 T ½ (1 day) is prudent to return to breastfeeding after a dose of abuse.

Co-sleeping with the baby is not recommended if this drug is being taken. (UNICEF 2013, Landa 2012, ABM 2008, UNICEF 2006)


See below the information of this related product:

  • Morphine (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)

Alternatives

  • Buprenorphine Hydrochloride (Safe substance and/or breastfeeding is the best option.)
  • Clonidine (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
  • Dextropropoxyphene (Unsafe. Moderate/severe adverse effects. Compatible under certain circumstances. Follow-up recommended. Use safer alternative or discontinue breastfeeding from 5 to 7 T ½ . Read Commentary.)
  • Methadone Hydrochloride (Safe substance and/or breastfeeding is the best option.)
  • Naltrexone Hydrochloride (Safe substance and/or breastfeeding is the best option.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

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Other names

Heroin Hydrochloride is also known as


Heroin Hydrochloride in other languages or writings:

Groups

Heroin Hydrochloride belongs to these groups or families:

Tradenames

Main tradenames from several countries containing Heroin Hydrochloride in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 23 (16 - 29) %
Molecular weight 424 daltons
Protein Binding < 35 %
VD 1 - 6 l/Kg
pKa 7.6 -
Tmax oral 0.5 - 1 Sc 0.2 im 0.1 hours
T½ 0.1 (morfin: 1.5 - 3) hours
M/P ratio 2.5 -
Relative Dose Morfin: 9 - 35 %

References

  1. UNICEF UK. Caring for your baby at night. A guide for parents. 2018 Full text (link to original source) Full text (in our servers)
  2. UNICEF. Ball H, Blair PS. (For UNICEF UK). Caring for your baby at night. Health professional´s guide. 2017 Full text (link to original source) Full text (in our servers)
  3. Vallersnes OM, Dines AM, Wood DM, Yates C, Heyerdahl F, Hovda KE, Giraudon I; Euro-DEN Research Group., Dargan PI. Psychosis associated with acute recreational drug toxicity: a European case series. BMC Psychiatry. 2016 Aug 18;16:293. Abstract Full text (link to original source)
  4. Eslami-Shahrbabaki M, Barfeh D, Eslami-Shahrbabaki P. Breastfeeding: Neglect or Excessive Support? A Case Report of Child Abuse by a Negligent Heroin-Dependent Mother. Addict Health. 2015 Abstract Full text (link to original source) Full text (in our servers)
  5. UNICEF UK. Statement on co-sleeping following publication of new NICE postnatal guidance. Infosheet. 2014 Full text (link to original source) Full text (in our servers)
  6. Sachs HC; Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013 Sep;132(3):e796-809. Abstract Full text (link to original source) Full text (in our servers)
  7. UNICEF UK Baby Friendly Initiative statement on Bed-sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case-control studies. None 2013 Full text (link to original source) Full text (in our servers)
  8. D'Apolito K. Breastfeeding and substance abuse. Clin Obstet Gynecol. 2013 Mar;56(1):202-11. Abstract
  9. L.Landa Rivera, M.Díaz-Gómez, A.Gómez Papi, J.M.Paricio Talayero, C.Pallás Alonso, M.T.Hernández Aguilar, J.Aguayo Maldonado, J.M.Arena Ansotegui, S.Ares Segura, A.Jiménez Moya, J.J.Lasarte Velillas, J.Martín Calama, M.D.Romero Escós. El colecho favorece la práctica de la lactancia materna y no aumenta el riesgo de muerte súbita del lactante. Dormir con los padres. Rev Pediatr Aten Primaria. 14:53-60 2012 Full text (link to original source) Full text (in our servers)
  10. Marchei E, Escuder D, Pallas CR, Garcia-Algar O, Gómez A, Friguls B, Pellegrini M, Pichini S. Simultaneous analysis of frequently used licit and illicit psychoactive drugs in breast milk by liquid chromatography tandem mass spectrometry. J Pharm Biomed Anal. 2011 May 15;55(2):309-16. Abstract
  11. Joya X, Fríguls B, Simó M, Civit E, de la Torre R, Palomeque A, Vall O, Pichini S, Garcia-Algar O. Acute heroin intoxication in a baby chronically exposed to cocaine and heroin: a case report. J Med Case Rep. 2011 Abstract Full text (link to original source) Full text (in our servers)
  12. ABM - Comité de protocolos de la Academia médica de lactancia materna (Academy of Breastfeeding Medicine). Protocolo Clínico de la ABM #6: Lineamientos sobre la práctica de dormir al bebé junto con la madre y la lactancia materna Revisión, marzo de 2008. Breastfeeding Medicine 2008 Full text (link to original source) Full text (in our servers)
  13. ABM - The Academy of Breastfeeding Medicine Protocol Committee. ABM Clinical Protocol #6: Guideline on Co-Sleeping and Breastfeeding. Breastfeeding Medicine 2008 Abstract Full text (link to original source) Full text (in our servers)
  14. vande Velde S, Verloo P, Van Biervliet S, Robberecht E. Heroin withdrawal leads to metabolic alkalosis in an infant with cystic fibrosis. Eur J Pediatr. 2007 Abstract
  15. UNICEF UK. Compartiendo la cama con tu bebé. Guía para madres que amamantan. Folleto 2006 Full text (in our servers)
  16. Moretti ME, Lee A, Ito S. Which drugs are contraindicated during breastfeeding? Practice guidelines. Can Fam Physician. 2000 Sep;46:1753-7. Review. Abstract Full text (link to original source) Full text (in our servers)
  17. Spagnolli W, De Venuto G, Mattarei M, Dal Ri P, Miori R. Prolactin and thyrotropin pituitary response to thyrotropin releasing hormone in young female heroin addicts. Drug Alcohol Depend. 1987 Abstract
  18. Wilson GS, McCreary R, Kean J, Baxter JC. The development of preschool children of heroin-addicted mothers: a controlled study. Pediatrics. 1979 Abstract
  19. Pelosi MA, Sama JC, Caterini H, Kaminetzky HA. Galactorrhea-amenorrhea syndrome associated with heroin addiction. Am J Obstet Gynecol. 1974 Abstract

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