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Dental abscess - Management
Which analgesic is suitable for use during pregnancy or breastfeeding?

  • Paracetamol is preferred because it can be given at all stages of pregnancy and during breastfeeding [Schaefer et al, 2007].
  • Codeine may be used as an analgesic for pregnant women if paracetamol is not sufficiently effective. However, there is a potential to cause neonatal respiratory depression when used near to term [Schaefer et al, 2007].
    • Although the amount of codeine excreted in breast milk is usually too small to be harmful, the British National Formulary warns that mothers vary considerably in their capacity to metabolize codeine, and fatal morphine toxicity has been reported in infants [BNF 54, 2007]. It has been recommended that codeine should only be used for short periods, and repeated dosages require close observation for somnolence [Schaefer et al, 2007].
  • The nonsteroidal anti-inflammatory drug (NSAID), ibuprofen, can be considered for use during pregnancy (up to 27 weeks of gestation) and breastfeeding [Schaefer et al, 2007].
    • Pregnancy
      • Ibuprofen should not used beyond 27 weeks of gestation because this can lead to heart problems in the neonate (increased risk of constriction of the ductus arteriosus) [Schaefer et al, 2007].
    • Breastfeeding
      • Ibuprofen was not detected in breast milk following administration of 800–1600 mg daily in two small studies. No adverse effects on breastfed children were reported in both studies and also in a prospective study covering 21 mother-child pairs [Schaefer et al, 2007].

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