Hydrocortisone use while Breastfeeding
Drugs containing Hydrocortisone: Cortisporin Otic, Anusol-HC, Cortef, Proctozone HC, Solu-Cortef, Proctosol-HC, Westcort, Anucort-HC, Analpram-HC, Pramosone, Show all 237 »Epifoam, Locoid, Cortisporin-TC, Anusol-HC Suppositories, Proctofoam HC, Hytone, Cortisporin Ophthalmic Suspension, Cortizone-10, Hydrocortisone 1% In Absorbase, Coly-Mycin S, Cortaid, Xerese, Hydrocort cream, Vytone, Ana-Lex, Preparation H Anti-Itch Cream Hydrocortisone 1%, Otomar HC, Colocort, Proctocream-HC, Cortenema, Hydrocortone, Alcortin, Cortifoam, A-Hydrocort, Proctocort, Oticin HC, HC-Derma-Pax, Novacort, Cortisporin Ophthalmic Ointment, Acetasol HC, Cortane-B, Cipro HC, HC Pramoxine, Triple Antibiotic HC Ophthalmic Ointment, Vosol HC, Locoid Lipocream, Dermazene, Anuzone HC, MyOxin, Analpram Advanced, Scalpicin, Instacort, Procto-Pak 1%, Alcortin A, Cortane, Hycort, HC Pram, Dermarest Eczema Medicated, Ala-Cort, Pediotic, Aeroseb-HC, Cetacort, Texacort, Rectasol-HC, Cortizone-10 Intensive Healing Formula, Dermacort, Rectacort-HC, Corticaine, Cortomycin Suspension, Lipsovir, Antibiotic Ear, AnaMantle HC, RectaGel HC, Oticot HC, Uremol HC, Lidazone HC, Hemmorex-HC, ProctoCare-HC, Anusol HC-1, Acticort 100, Anusert HC-1, Dermol HC, Cortizone-10 Anal Itch Cream, Proctozone-H, Cortizone-10 Plus, Pandel, Anurx-HC, Hemril-HC Uniserts, Zolene HC, Aero Otic HC, Exotic-HC, Zoto-HC Drops, Oto-End, Zypram, Pramox-HC, Cortisporin Cream, Ala-Quin, Vio-Tex-HC, Dermasorb AF, Pramcort, Otirx, Neotricin HC, Analpram E, Procort, Lodocort Aloe, Ketocon+Plus, Hemril-30, Xolegel CorePak, Dermtex HC, Otobiotic, Xyralid LP, BP Ana-Lex HC, Proctosert HC, Dermarest Dricort, Massengill Medicated Soft Cloth, Monistat Soothing Care Itch Relief Cream, Xyralid, U-Cort, Tucks Hydrocortisone Anti-Itch Ointment, Encort, Cortaid Maximum Strength, NuZon, Gynecort Maximum Strength, Cortaid Intensive Therapy, Aqua Glycolic HC, Cortalo with Aloe, NuCort with Aloe, Nutracort, LidaMantle HC Relief, Cortatrigen Modified, Otocort Sterile Solution, Otimar, Masporin Otic, AK-Spore HC Otic Suspension, Drotic, Zone-A, Enzone, Pramosone E, Scalacort DK, Hydropram, Rectocort HC, Zone-A Forte, Cortomycin, Otocort Sterile Suspension, Neutrogena T-Scalp, Lidocort, Rectacreme HC, LidaMantle HC, Senatec HC, Peranex HC, Xyralid RC, Coraz, Cortatrigen, UAD Otic, Neo/PolyB/HC, Cort-Biotic, Oti-Sone, AnaMantle HC Forte, GRx HiCort 25, Pedi-Cort V, 1 Plus 1 F, FIRST Duke's Mouthwash, Hysone, Dek-Quin, Corque, Iodo-HC, Steroform, FIRST Mary's Mouthwash, Hydrocortone Phosphate, NuCort, Hydrocortisone with Aloe, Dermasorb HC, Keratol HC, Ala-Scalp, Vagisil Satin Anti-Itch Creme, Carmol HC, MD Hydrocortisone, Cortane-B Lotion, Hydro Ear, Ocu-Cort, Cortisporin Ointment, Trioxin, Neo-Poly-Bac, Cortomycin Eye Ointment, Vasotate HC, Earsol-HC, Neo-Polycin HC, Bencort, Vanoxide-HC, Cortic-ND, IvDerm, Cortamox, Cyotic, Tri-Otic, Ophthocort, Mantadil, Otozone, Cort-Dome High Potency, Procto-Kit 1%, Rederm, Sarnol-HC, Scalp-Aid, Recort Plus, Nogenic HC, Scalacort, Gly-Cort, Hi-Cor, Cort-Dome, Genasone/Aloe, Nupercainal HC 1%, Dermarest Plus Anti-Itch, Cortizone-5, Bioelements Immediate Comfort, Ivocort, Instacort 10, Scalp-Cort, Beta HC, Dermolate, Pediaderm HC, Lacticare-HC, Orabase HCA, Ala-Scalp HP, Cotacort, Penecort, Procto-Kit 2.5%, Anuprep-HC, Anumed-HC, Hemorrhoidal HC, Anutone-HC, Itch-X Lotion, Corticreme, Delcort, Caldecort, Aquanil HC, Cortaid with Aloe, Aloe Cort, Cortizone for Kids
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. Hydrocortisone in breastmilk is stable at room temperature and during repeated freeze-thaw cycles.
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.
Numerous methods have been used to measure cortisol in milk. Some have measured only unconjugated cortisol and others have hydrolyzed sulfate and glucuronide conjugates to measure total cortisol. Neonates are unable to deconjugate these moieties, so the age of the infant affects the relevance of findings.
Maternal Levels. 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).
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.
Thirteen full-term mothers donated milk between 8 and 28 weeks postpartum. Unconjugated cortisol concentrations ranged from 1.45 to 8.34 mcg/L. 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.
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. 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. An equivalent dosage regimen of hydrocortisone might have the same effect.
Alternate Drugs to Consider
1. van der Voorn B, Martens F, Peppelman NS et al. Determination of cortisol and cortisone in human mother's milk. Clin Chim Acta. 2015;444:154-5. PMID: 25687161
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
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