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Hydrocortisone use while Breastfeeding

Drugs containing Hydrocortisone: Cortisporin Otic, Anusol-HC, Cortef, Proctosol-HC, Solu-Cortef, Proctozone HC, Anucort-HC, Westcort, Anusol-HC Suppositories, Analpram-HC, Show all 232 »Proctofoam HC, Hytone, Pramosone, Cortisporin Ophthalmic Suspension, Cortisporin-TC, Cipro HC, Locoid, Hydrocortisone 1% In Absorbase, Cortizone-10, Proctocort, Antibiotic Ear, Vosol HC, Cortaid, Cortatrigen, Hydrocort cream, Cortane-B, Cortenema, HC Pramoxine, Procort, Locoid Lipocream, Cortisporin Ointment, Analpram Advanced, Triple Antibiotic HC Ophthalmic Ointment, Trioxin, MyOxin, Alcortin A, Anusol HC-1, U-Cort, Preparation H Anti-Itch Cream Hydrocortisone 1%, Proctozone-H, Anuzone HC, Hycort, Pandel, Uremol HC, FIRST Mary's Mouthwash, Cortisporin Cream, AnaMantle HC, Rectocort HC, Vytone, Zoto-HC Drops, Nupercainal HC 1%, Cortifoam, Cortisporin Ophthalmic Ointment, Colocort, Acticort 100, Alcortin, Zone-A, Otomar HC, Ala-Cort, GRx HiCort 25, Aeroseb-HC, Texacort, BP Ana-Lex HC, Ketocon+Plus, Dermazene, Oto-End, Ana-Lex, Procto-Pak 1%, Rectacreme HC, Encort, ProctoCare-HC, Monistat Soothing Care Itch Relief Cream, Xerese, Nutracort, Cortizone-5, Proctocream-HC, Lacticare-HC, Rectasol-HC, Lidocort, Hemorrhoidal HC, Corticaine, Ivocort, RectaGel HC, Xyralid, Hydrocortisone with Aloe, Enzone, Ophthocort, Pramox-HC, Coly-Mycin S, Otirx, Hydropram, Hydrocortone, A-Hydrocort, Neo-Poly-Bac, Analpram E, Otobiotic, Drotic, Otozone, Cortalo with Aloe, Aqua Glycolic HC, Instacort, Scalpicin, Lodocort Aloe, Oti-Sone, Xolegel CorePak, NuCort with Aloe, Cortaid Intensive Therapy, Dermtex HC, Cortizone-10 Plus, Massengill Medicated Soft Cloth, Dermarest Dricort, Cortizone for Kids, Neutrogena T-Scalp, Hemril-30, Proctosert HC, NuZon, Gynecort Maximum Strength, Tucks Hydrocortisone Anti-Itch Ointment, Cort-Biotic, Cortaid Maximum Strength, Dermarest Eczema Medicated, Xyralid LP, Masporin Otic, AK-Spore HC Otic Suspension, Otocort Sterile Solution, Cortatrigen Modified, Scalacort DK, Epifoam, Cortomycin, HC Pram, Novacort, Dermarest Plus Anti-Itch, Zone-A Forte, Pramcort, Zypram, Neo/PolyB/HC, Cortomycin Suspension, Lidazone HC, Otimar, Pramosone E, Pediotic, Otocort Sterile Suspension, AnaMantle HC Forte, Senatec HC, Xyralid RC, Coraz, LidaMantle HC Relief, LidaMantle HC, Peranex HC, UAD Otic, Anuprep-HC, Dek-Quin, Hysone, Vio-Tex-HC, Ala-Quin, Steroform, Iodo-HC, Cortane-B Lotion, Dermasorb AF, Corque, Pedi-Cort V, 1 Plus 1 F, MD Hydrocortisone, Ala-Scalp, Keratol HC, Carmol HC, Vagisil Satin Anti-Itch Creme, HC-Derma-Pax, FIRST Duke's Mouthwash, Hydrocortone Phosphate, Hydro Ear, Cortamox, Cortomycin Eye Ointment, Ocu-Cort, Neotricin HC, Lipsovir, Oticot HC, Acetasol HC, Vasotate HC, Earsol-HC, Bencort, Vanoxide-HC, Cortic-ND, Aero Otic HC, IvDerm, Zolene HC, Cyotic, Mantadil, Tri-Otic, Exotic-HC, Dermasorb HC, Cort-Dome High Potency, Scalacort, Gly-Cort, Hi-Cor, Nogenic HC, Dermolate, Dermol HC, Corticreme, Delcort, Pediaderm HC, Recort Plus, Rederm, Scalp-Cort, Beta HC, Cortizone-10 Anal Itch Cream, Instacort 10, Genasone/Aloe, Sarnol-HC, Scalp-Aid, Cort-Dome, Itch-X Lotion, Caldecort, Anumed-HC, Hemril-HC Uniserts, Penecort, Procto-Kit 2.5%, Procto-Kit 1%, Cetacort, Dermacort, Cortizone-10 Intensive Healing Formula, Cotacort, Orabase HCA, Cortaid with Aloe, Aloe Cort, Aquanil HC, Anusert HC-1, Anurx-HC, Ala-Scalp HP, Cortane, Anutone-HC, Bioelements Immediate Comfort

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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