Can you take remifentanil 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.
Because the half-life of remifentanil is extremely short, it is unlikely to cause any adverse effects in the breastfed newborn if it is given to the mother for labor analgesia or a surgical procedure. Maternal use of opioids during breastfeeding can cause infant drowsiness, which may progress to rare but severe central nervous system depression. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. If the mother of a newborn requires remifentanil, 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 of remifentanil to a few 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. Because no information is available on the use of remifentanil during breastfeeding, an alternate drug may be preferred if the mother requires prolonged administration of remifentanil during the early postpartum period. Withdrawal symptoms can occur in breastfed infants when maternal administration of an opioid analgesic is stopped, or when breastfeeding is stopped.
Quoted from Remifentanil — 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 remifentanil. Whether any of them fits depends on what you are treating — this is the database’s list, not a recommendation from us.
How much remifentanil gets into breastmilk
Remifentanil is administered intravenously and has a half-life of about 3 minutes in adults. Its oral bioavailability is unknown.
Maternal Levels. Relevant published information was not found as of the revision date.
Infant Levels. Relevant published information was not found as of the revision date.
What has been seen in breastfed infants
Four mothers who were breastfeeding their infants received remifentanil as part of their general anesthesia for surgical procedures. All patients also received intravenous propofol and rocuronium, and inhaled xenon as part of the anesthesia. They were given doses of remifentanil that targeted a serum concentration of 4.5 mcg/L during the procedure and reduced to achieve a target concentration of 1.5 mcg/L at the end of anesthesia. Individual infants were first breastfed as follows: 1.5 hours, 2.8 hours, 4.6 hours, and 5 hours after extubation. No signs of sedation were observed in any of the infants.
Effects on milk supply
Narcotics can increase serum prolactin. However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.
A double-blind, randomized study compared patient-controlled intravenous (IV) analgesia with remifentanil (n = 43) to a continuous meperidine infusion (n = 45) for labor analgesia. Patients receiving remifentanil used an average total dosage of 1035 mcg/kg and those receiving meperidine received an average total dosage of 150 mg/kg. Breastfeeding difficulties were experienced in 6.3% of the infants of mothers who received remifentanil and 12.8% of infants whose mothers received meperidine; however, this difference was not statistically significant.
Frequently asked questions
Can you take remifentanil while breastfeeding?
What the NIH's Drugs and Lactation Database says about Remifentanil 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 remifentanil while breastfeeding?
LactMed lists Butorphanol, Fentanyl, Hydromorphone, Morphine 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 remifentanil pass into breastmilk?
LactMed's measured drug levels for remifentanil are quoted in full on this page, under "How much gets into breastmilk".
Do I need to pump and dump after taking remifentanil?
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 remifentanil
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.