Hydrocortisone use while Breastfeeding

Drugs containing Hydrocortisone: Cortisporin Otic, Anusol-HC, Cortef, Solu-Cortef, Westcort, Proctosol-HC, Analpram-HC, Anucort-HC, Proctozone HC, Anusol-HC Suppositories, Show all 230 »Proctofoam HC, Cortisporin-TC, Cipro HC, Cortisporin Ophthalmic Suspension, Epifoam, Hydrocortisone 1% In Absorbase, Hytone, Vytone, Alcortin, Locoid, Cortizone-10, Procort, Proctocream-HC, Xerese, Pramosone, Cortaid, Hycort, Cortifoam, Proctocort, Cortisporin Ointment, Alcortin A, Acetasol HC, Cortenema, Hydrocortisone with Aloe, Hydrocort cream, Ala-Cort, AnaMantle HC, Vosol HC, Hydrocortone, Novacort, Coly-Mycin S, LidaMantle HC, Colocort, Dermasorb AF, Anusol HC-1, Nupercainal HC 1%, Proctozone-H, Cortane-B, Cortizone-10 Anal Itch Cream, Preparation H Anti-Itch Cream Hydrocortisone 1%, Texacort, Aeroseb-HC, Oto-End, Pramosone E, Antibiotic Ear, Cortisporin Cream, Uremol HC, Cetacort, Lipsovir, Dermazene, Cortomycin Eye Ointment, Cortisporin Ophthalmic Ointment, Scalpicin, Proctosert HC, Aquanil HC, Zypram, Scalp-Cort, Pandel, Vagisil Satin Anti-Itch Creme, Hemorrhoidal HC, Acticort 100, HC Pramoxine, Hysone, Exotic-HC, Encort, Gynecort Maximum Strength, ProctoCare-HC, Ocu-Cort, Locoid Lipocream, Neutrogena T-Scalp, Caldecort, Corticaine, Delcort, Sarnol-HC, Pediotic, Cortomycin, Enzone, Rectocort HC, Xyralid, Lidocort, Otomar HC, Ketocon+Plus, Triple Antibiotic HC Ophthalmic Ointment, Earsol-HC, Analpram E, Rectasol-HC, Lacticare-HC, 1 Plus 1 F, Analpram Advanced, Dermacort, Trioxin, Bencort, Ala-Quin, U-Cort, Xyralid LP, Lodocort Aloe, Hemril-30, BP Ana-Lex HC, Cortaid Maximum Strength, Xolegel CorePak, Anuzone HC, Cortizone-10 Plus, NuZon, Monistat Soothing Care Itch Relief Cream, Instacort, Nutracort, Lidazone HC, Aqua Glycolic HC, Cortalo with Aloe, Tucks Hydrocortisone Anti-Itch Ointment, Dermarest Eczema Medicated, Procto-Pak 1%, NuCort with Aloe, Cortaid Intensive Therapy, Neo/PolyB/HC, Cortatrigen Modified, Otocort Sterile Solution, Otimar, Otocort Sterile Suspension, Cortatrigen, UAD Otic, HC Pram, Pramcort, Zone-A Forte, Dermtex HC, Zone-A, Drotic, Masporin Otic, Cort-Biotic, Oti-Sone, Rectacreme HC, LidaMantle HC Relief, Peranex HC, RectaGel HC, Senatec HC, Xyralid RC, Cortomycin Suspension, AK-Spore HC Otic Suspension, Scalacort DK, Coraz, Hydropram, Otobiotic, AnaMantle HC Forte, Cortizone-10 Intensive Healing Formula, Dek-Quin, Vio-Tex-HC, Pedi-Cort V, Steroform, Iodo-HC, Pramox-HC, Cortane-B Lotion, Corque, HC-Derma-Pax, FIRST Duke's Mouthwash, Ala-Scalp, Keratol HC, Dermasorb HC, MD Hydrocortisone, Carmol HC, FIRST Mary's Mouthwash, Hydrocortone Phosphate, A-Hydrocort, Hydro Ear, Cortamox, Vanoxide-HC, Ophthocort, Mantadil, MyOxin, Neotricin HC, Vasotate HC, Oticot HC, Neo-Poly-Bac, Otozone, Zoto-HC Drops, Cortic-ND, Aero Otic HC, IvDerm, Otirx, Zolene HC, Tri-Otic, Cyotic, Cort-Dome High Potency, Procto-Kit 1%, Rederm, Scalp-Aid, Cort-Dome, Recort Plus, Nogenic HC, Scalacort, Gly-Cort, Hi-Cor, Genasone/Aloe, Instacort 10, Cortizone-5, Cortizone for Kids, Dermarest Dricort, Dermarest Plus Anti-Itch, Bioelements Immediate Comfort, Beta HC, Ivocort, Dermolate, Dermol HC, Cotacort, Orabase HCA, Ala-Scalp HP, Penecort, Hemril-HC Uniserts, Procto-Kit 2.5%, Anuprep-HC, Anumed-HC, Cortane, Anutone-HC, Itch-X Lotion, Corticreme, Pediaderm HC, Aloe Cort, Cortaid with Aloe, Anurx-HC, Anusert HC-1, Massengill Medicated Soft Cloth

Hydrocortisone Levels and Effects while Breastfeeding

Summary of Use during Lactation

Hydrocortisone (cortisol) is a normal component of breastmilk that passes from the mother's bloodstream into milk. Hydrocortisone has not been studied in breastmilk after exogenous administration in pharmacologic amounts. Although it is unlikely that dangerous amounts of hydrocortisone would reach the infant, a better studied alternate corticosteroid might be preferred. Use of hydrocortisone as an enema would not be expected to cause any adverse effects in breastfed infants. Local injections, such as for tendinitis, would not be expected to cause any adverse effects in breastfed infants, but might occasionally cause temporary loss of milk supply. See also Hydrocortisone, Topical.

Drug Levels

Maternal Levels. An unspecified number of mothers had endogenous breastmilk cortisol (hydrocortisone) levels measured at various random times postpartum. Milk cortisol levels ranged from 7 to 33 mcg/L during the first 10 days postpartum; levels after 40 days postpartum were 6 to 17 mcg/L.[1]

Cortisol was measured in the colostrum and milk of 11 women monthly for up to 12 months postpartum. Levels in late pregnancy averaged 24.5 mcg/L and fell over the first 10 days postpartum to an average of 1.8 mcg/L. Milk cortisol levels between months 2 and 12 averaged 7.2 mcg/L, but varied with time and among individuals (range 0.2 to 32 mcg/L).[2]

Free cortisol was measured in 13 women on days 1, 2, and 3 postpartum (7 spontaneous births) or days 3, 4, and 5 postpartum (6 elective cesarean sections). Milk levels were measured before and after nursing, but the values were not statistically different. In the women with spontaneous deliveries, before and after milk levels averaged 17.2 mcg/L on day 1, 16.8 mcg/L on day 2, and 7.4 mcg/L on day 3 postpartum. In the women with cesarean deliveries, before and after milk levels averaged 26.5 mcg/L on day 3, 15.1 mcg/L on day 4, and 14.1 mcg/L on day 6 postpartum.[3]

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

None reported with any systemic corticosteroid.

Effects on Lactation and Breastmilk

Published information on the effects of hydrocortisone on serum prolactin or on lactation in nursing mothers was not found as of the revision date. However, medium to large doses of depot corticosteroids injected into joints have been reported to cause temporary reduction of lactation.[4][5]

A study of 46 women who delivered an infant before 34 weeks of gestation found that a course of another corticosteroid (betamethasone, 2 intramuscular injections of 11.4 mg of betamethasone 24 hours apart) given between 3 and 9 days before delivery resulted in delayed lactogenesis II and lower average milk volumes during the 10 days after delivery. Milk volume was not affected if the infant was delivered less than 3 days or more than 10 days after the mother received the corticosteroid.[6] An equivalent dosage regimen of hydrocortisone might have the same effect.

A study of 87 pregnant women found that betamethasone given as above during pregnancy caused a premature stimulation of lactose secretion during pregnancy. Although the increase was statistically significant, the clinical importance appears to be minimal.[7] An equivalent dosage regimen of hydrocortisone might have the same effect.

Alternate Drugs to Consider

(Systemic) Methylprednisolone, Prednisolone, Prednisone

References

1. Rosner W, Beers PC, Awan T, Khan MS. Identification of corticosteroid-binding globulin in human milk: measurement with a filter disk assay. J Clin Endocrinol Metab. 1976;42:1064-73. PMID: 932172

2. Kulski JK, Hartmann PE. Changes in the concentration of cortisol in milk during different stages of human lactation. Aust J Exp Biol Med Sci. 1981;59 (Pt 6):769-78. PMID: 7340774

3. Patacchiolo FR, Cigliana G, Cilumbriello A et al. Maternal plasma and milk free cortisol during the first 3 days of breast-feeding following spontaneous delivery or elective cesarean section. Gynecol Obstet Investig. 1992;34:159-63. PMID: 1427417

4. McGuire E . Sudden loss of milk supply following high-dose triamcinolone (Kenacort) injection. Breastfeed Rev. 2012;20:32-4. PMID: 22724311

5. Babwah TJ, Nunes P, Maharaj RG. An unexpected temporary suppression of lactation after a local corticosteroid injection for tenosynovitis. Eur J Gen Pract. 2013;19:248-50. PMID: 24261425

6. Henderson JJ, Hartmann PE, Newnham JP, Simmer K. Effect of preterm birth and antenatal corticosteroid treatment on lactogenesis ii in women. Pediatrics. 2008;121:e92-100. PMID: 18166549

7. Henderson JJ, Newnham JP, Simmer K, Hartmann PE. Effects of antenatal corticosteroids on urinary markers of the initiation of lactation in pregnant women. Breastfeed Med. 2009;4:201-6. PMID: 19772378

Hydrocortisone Identification

Substance Name

Hydrocortisone

CAS Registry Number

50-23-7

Drug Class

Corticosteroids, Systemic

Glucocorticoids

Anti-Inflammatory Agents

Administrative Information

LactMed Record Number

138

Last Revision Date

20131206

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