Page 441 Acute Pain Management

Drug Comments
Local anaesthetics
bupivacaine, cinchocaine, levobupivacaine Unlikely to cause problems
lignocaine (lidocaine), mepivacaine, prilocaine,
ropivacaine
Antidepressants
SSRIs: SSRIs are used in postnatal depression (some
citalopram, fluvoxamine, paroxetine, sertraline consider sertraline one of the preferred
antidepressants in breastfeeding).
fluoxetine Use an alternative SSRI because of fluoxetine's
long half‐life
Tricyclic antidepressants (TCAs):
amitriptyline, clomipramine, dothiepin TCAs have been used to treat postnatal
(dosulepin), doxepin, imipramine, nortriptyline, depression. Avoid doxepin if possible; a single
trimipramin case of neonatal respiratory depression has been
reported
Other antidepressants: Appears to be safe; contact specialised
moclobemide information service
mirtazapine, venlafaxine Contact specialised information service
Anticonvulsants
carbamazepine Safe to use; monitor infant for drowsiness and
poor suckling
phenytoin sodium May be used
sodium valproate Should be safe to use
clonazepam Risk of sedation in infant; contact specialised
information service
gabapentin, tiagabine Contact specialised information service
pregabalin No data available
lamotrigine, topiramate Excreted in breast milk; contact specialised
information service
Antiemetics, antinauseants
Phenothiazines: Safe to use
prochlorperazine
promethazine Safe to use; however, may cause drowsiness or
tiredness in mother CHAPTER 11
Others:
dimenhydrinate Safe to use
metoclopramide Safe to use (used to stimulate lactation)
dolasetron, granisetron, ondansetron, Contact specialised information service; no data
tropisetron available, although 1 or 2 doses after delivery
should not be a concern
domperidone Used during first months of breastfeeding to
stimulate lactation; mother may be less drowsy
than with metoclopramide
hyoscine hydrobromide Safe to use occasional doses

Acute pain management: scientific evidence 393