Can you take butorphanol while breastfeeding?
What LactMed says
The National Library of Medicine’s own summary, quoted in full. We do not write a verdict of our own on this question, and we do not compress theirs into a label.
Maternal use of oral opioids during breastfeeding can cause infant drowsiness, which may progress to rare but severe central nervous system depression. Limited data indicate that butorphanol is excreted into breastmilk in small amounts. Butorphanol is poorly orally absorbed, so it is unlikely to adversely affect the breastfed infant. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants. If butorphanol is required by the mother of a newborn, it is not a reason to discontinue breastfeeding; however, once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake to 2 to 3 days with close infant monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. Withdrawal symptoms can occur in breastfed infants when maternal administration of an opioid analgesic is stopped, or when breastfeeding is stopped. Labor pain medication may delay the onset of lactation. Because there is no published experience with repeated, high intravenous or intranasal doses of butorphanol during breastfeeding, other agents may be preferred in these situations, especially while nursing a newborn or preterm infant
Quoted from Butorphanol — Drugs and Lactation Database (LactMed®), National Institute of Child Health and Human Development, revised December 15, 2025.
What LactMed would consider instead
LactMed ends this record by naming the drugs it would consider in place of butorphanol. Whether any of them fits depends on what you are treating — this is the database’s list, not a recommendation from us.
How much butorphanol gets into breastmilk
In adults, the oral bioavailability of butorphanol is 17% while the intranasal bioavailability is 70%. Butorphanol is metabolized to inactive metabolites. Intranasal and parenteral doses of 25 to 30 mcg/kg have been used in infants as young as 6 months for postoperative analgesia.
Maternal Levels. Twelve lactating women were given a single butorphanol dose at 2 to 4 days postpartum. Six of these women were given a 2 mg single intramuscular dose and 6 others were given a single 8 mg oral dose. Milk was sampled 3 times after the dose. The reported average milk levels were 1.5, 0.7 and 0.3 mcg/L at 2, 4 and 8 hours, respectively, after the 2 mg intramuscular dose. The average milk levels after the 8 mg oral dose were 3.6, 1.8 and 1.1 mcg/L at 3, 5 and 8 hours, respectively. The half-life of elimination from milk was about 2 hours. Using the data from this study, doses of butorphanol 2 mg intramuscularly or 8 mg orally will result in average milk levels of 0.7 and 2 mcg/L, respectively, over 8 hours after the dose. Using these calculated average milk levels, an exclusively breastfed infant would receive 0.035 mcg/kg from a 2 mg intramuscular maternal dose of butorphanol, and 0.1 mcg/kg from an 8 mg oral maternal dose of butorphanol, from milk ingested up through 8 hours after the dose. These amounts represent 0.11% and 0.08% of the maternal weight-adjusted dosages, respectively.
Infant Levels. Relevant published information was not found as of the revision date.
What has been seen in breastfed infants
Relevant published information was not found as of the revision date.
Effects on milk supply
Narcotics and narcotic agonist-antagonists can increase serum prolactin. However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.
A study compared women who received butorphanol or nalbuphine during labor (n = 26) to those who received no analgesia (n = 22). The time to effective breastfeeding was longer (46.5 minutes) in the analgesia group than in the no analgesia group (35.4 minutes).
A national survey of women and their infants from late pregnancy through 12 months postpartum compared the time of lactogenesis II in mothers who did and did not receive pain medication during labor. Categories of medication were spinal or epidural only, spinal or epidural plus another medication, and other pain medication only. Women who received medications from any of the categories had about twice the risk of having delayed lactogenesis II (>72 hours) compared to women who received no labor pain medication.
A double-blind study compared women undergoing cesarean section with combined spinal-epidural anesthesia. Women received either intranasal saline, 1 mg of intranasal butorphanol after delivery of the infant or 5 mg of intravenous butorphanol by PCA pump after closure of the abdomen. All patients received 1.5 mcg/kg of sufentanil and 10 mg tropisetron intravenously by PCA pump after delivery. No significant differences among the 3 groups on the time to initiation of lactation (26 to 27 hours) and no significant differences in prolactin levels pre- and postoperatively.
A study in women undergoing a normal delivery compared the use of epidural alone to a combination of butorphanol nasal spray preceding epidural administration
Frequently asked questions
Can you take butorphanol while breastfeeding?
What the NIH's Drugs and Lactation Database says about Butorphanol while breastfeeding — quoted in full. The full record is quoted on this page, and the decision is one to make with the person who prescribed it — LactMed itself states it is not a substitute for professional judgement.
What can I take instead of butorphanol while breastfeeding?
LactMed lists Acetaminophen, Hydromorphone, Ibuprofen, Morphine, Nalbuphine as alternate drugs to consider. That is the database's own list for this drug — whether any of them suits you depends on what you are treating.
Does butorphanol pass into breastmilk?
LactMed's measured drug levels for butorphanol are quoted in full on this page, under "How much gets into breastmilk".
Do I need to pump and dump after taking butorphanol?
LactMed does not frame its records that way — it reports measured drug levels in milk and what has been observed in breastfed infants, which is what this page quotes. "Pump and dump" advice for a specific drug and dose should come from your clinician or a pharmacist, not from a general rule.
More on butorphanol
LactMed states that the information it presents is not a substitute for professional judgement, and that you should consult your healthcare provider for breastfeeding advice related to your particular situation. Nothing on this page is medical advice.