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Can Fam Physician
Vol. 53, No. 6, June 2007, pp.1005 - 1006
Copyright © 2007 by The College of Family Physicians of Canada
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Letters

Response

Gideon Koren, MD FRCPC
Director, Motherisk Program Hospital for Sick Children Toronto, Ont

Parvaz Madadi
London, Ont by e-mail

We wish to thank Dr Young for his interest in our Motherisk Update, and for his thoughtful observations.

The dose of 87 µg/L of milk calculated by him is not "such a small quantity" for a newborn. In fact, it is 30 µg/kg. In older infants a dose of 50 µg/kg is used for sedation. The newborn has much lower capacity to deactivate morphine.1 Moreover, the newborn has substantially higher sensitivity to the central effects of morphine, partially due to more penetration through the blood-brain barrier.2

Last, as we indicated in the paper, the homozygocity the child exhibited to glucuronidation of morphine might be associated with higher levels of the morphine-6-glucuronide metabolite, which is many times more active than morphine. We have not measured this metabolite in milk, but we are now in the process of doing so.

With research support from Genome Canada, we are currently studying the prevalence and risk of codeine use while breastfeeding.


   References
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 References
 

  1. Bouwmeester NJ, Anderson BJ, Tibboel D, Holford NH. Developmental pharmacokinetics of morphine and its metabolites in neonates, infants and young children. Br J Anaesth 2004;92:208-17.[Abstract/Free Full Text]
  2. Rai A, Bhalla S, Rebello SS, Katrissios H, Gulati A. Disposition of morphine in plasma and cerebrospinal fluid varies during neonatal development in pigs. J Pharm Pharmacol 2005;57:981-6.[Medline]




This Article
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