Methadone is the preferred choice of treatment for opioid dependence during breastfeeding. Recommendations apply to full term and healthy infants only.

General considerations

It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing in breastfeeding when looking at the available information and making treatment decisions.


Methadone is the preferred choice of treatment for opioid dependence during breastfeeding as there is more evidence and experience of its use.

There is less evidence and experience for the use of buprenorphine (including in combination with naloxone), or naltrexone.  However these are still considered compatible with breastfeeding.

Infants exposed to methadone, buprenorphine, or naltrexone during pregnancy can breastfeed as normal after delivery.

Breastfeeding has benefits to an infant who has been exposed to maternal opioids during pregnancy and may reduce any withdrawal symptoms in the infant.

The National Institute for Healthcare Excellence (NICE) advises avoiding sharing a bed with the infant when sedating medication has been used, due to the increased risk of sudden unexpected death in infancy.

Clinical Considerations

Treating opioid dependence in breastfeeding is a complex scenario. As well as the risks associated with exposing infants to substitution therapies through breast milk, wider clinical and social implications also need to be considered. The National Institute for Healthcare Excellence (NICE) Clinical Knowledge Summaries (CKS) provides further advice.

Infant withdrawal

Infants exposed to opioids during pregnancy should be observed for withdrawal symptoms. Opioids present in breast milk may decrease withdrawal symptoms, but may be insufficient to allow dose reduction of any treatment of the infant.

Withdrawal symptoms in the infant may also occur during breastfeeding if the mother stops taking the medication suddenly or breastfeeding stops suddenly.

Specific recommendations

Patient Information

The NHS website provides advice for patients on the use of specific medicines in breastfeeding.

Contact us

Get in touch with the UK Drugs In Lactation Advisory Service (UKDILAS), our specialist breastfeeding medicines advice service if you need support in the following situations:

  • you need further advice
  • the medicine in question is not included here
  • the infant is unwell or premature
  • multiple medicines are being taken

About our recommendations

Recommendations are based on published evidence where available. However, evidence is generally very poor and limited, and can require professional interpretation. Assessments are often based on reviewing case reports which can be conflicting and lack detail.

If there is no published clinical evidence, assessments are based on: pharmacodynamic and pharmacokinetic principles, extrapolation from similar drugs, risk assessment of normal clinical use, expert advice, and unpublished data. Simulated data is now increasingly being used due to the ethical difficulties around gathering good quality evidence in this area.


Full referencing is available on request.