Methylprednisolone use while Breastfeeding
Drugs containing Methylprednisolone: Medrol Dosepak, Solu-Medrol, Medrol, MethylPREDNISolone Dose Pack, Depo-Medrol, Methylpred DP, A-Methapred, Duralone, Medralone, Depmedalone, Show all 26 »Methacort 40, M-Prednisolone, Predacorten, Med-Jec-40, Methylcotolone, Hybrisil, Methylcotol, Methacort 80, Dep Medalone 80, Depoject-80, Depopred, Adlone-40, Adlone-80, Medralone 40, Medipred, Medralone 80
Methylprednisolone Levels and Effects while Breastfeeding
Summary of Use during Lactation
Limited information indicates that maternal doses of methylprednisolone up to 8 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants. With high maternal doses (such as 1 gram), especially intravenous doses as in multiple sclerosis relapse or monthly therapy, avoiding breastfeeding during the infusion and for 4 to 8 hours after a dose is recommended by various sources. However, this maneuver is not necessary for low doses. 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.
Maternal Levels In one woman taking 6 mg daily of methylprednisolone by mouth, 2 peak milk levels occurred: one at 2 hours after the dose and another 8 hours after the dose. Peaks were about 7 mcg/L, while levels fell to about 2.5 mcg/L 6 hours after the dose and to about 1 mcg/L 10 hours after the dose.
A woman with multiple sclerosis had a relapse in the first 3 months postpartum. She was given methylprednisolone 1 gram daily for 3 days. Milk samples were obtained after one of the doses. The breastmilk methylprednisolone was 3 mg/L immediately after the dose and 1.2 mg/L at 4 hours after the dose. The authors estimated that an infant who nurses at 4 hours after a dose will ingest 0.168 mg of methylprednisolone which is equivalent of 0.84 mg of cortisol or 42% of the daily output. An infant who nurses starting at 8 hours after a dose will ingest 0.048 mg of methylprednisolone which is equivalent to 12% of daily cortisol production. The authors did not specify their method of calculating these values.
Infant Levels. Relevant published information was not found as of the revision date.
Effects in Breastfed Infants
None reported with methylprednisolone or any other corticosteroid. None reported with methylprednisolone or any other corticosteroid. Three infants were breastfed from birth during maternal use of methylprednisolone 6 to 8 mg daily with no reported adverse effects up to 3 months. In one of the papers, 2 infants had normal blood cell counts, no increase in infections and above average growth rates.
Effects on Lactation and Breastmilk
A patient who was 6 weeks postpartum and predominantly breastfeeding her infant received 24 mg of depot methylprednisolone plus 15 mg of lidocaine intralesionally for tenosynovitis of the wrist. Thirty hours after the injection, lactation ceased. Her breasts were soft and not engorged at that time. Thirty-six hours later, lactation resumed slowly, reaching normal milk production 24 hours later. The author hypothesized that the suppression might have occurred because the injection was in a highly mobile joint, which might have caused rapid release of the corticosteroid. A large dose of triamcinolone injected into the shoulder has also been reported to cause temporary cessation 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 methylprednisolone 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 methylprednisolone might have the same effect.
Alternate Drugs to Consider
1. Bodiguel E, Bensa C, Brassat D et al. [Multiple sclerosis and pregnancy]. Rev Neurol (Paris). 2014;170:247-65. PMID: 24684929
2. Strijbos E, Coenradie S, Touw D, Aerden L. High-dose methylprednisolone for multiple sclerosis during lactation: Concentrations in breast milk. Mult Scler. 2015. PMID: 25583837
3. Coulam CB, Moyer TP, Jiang NS et al. Breast-feeding after renal transplantation. Transplant Proc. 1982;13:605-9. PMID: 6817481
4. Grekas DM, Vasiliou SS, Lazarides AN. Immunosuppresive therapy and breast-feeding after renal transplantation. Nephron. 1984;37:68. Letter. PMID: 6371564
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. McGuire E . Sudden loss of milk supply following high-dose triamcinolone (Kenacort) injection. Breastfeed Rev. 2012;20:32-4. PMID: 22724311
7. 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
8. 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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