Prednisone use while Breastfeeding

Drugs containing Prednisone: Deltasone, Sterapred, Rayos, Sterapred DS, Orasone, Meticorten, Prednicot, Prednicen-M, Liquid Pred

Prednisone Levels and Effects while Breastfeeding

Summary of Use during Lactation

Limited information indicates that maternal doses of prednisone up to 20 mg produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants. With high maternal doses, the use of prednisolone instead of prednisone and avoiding breastfeeding for 3 to 4 hours after a dose should decrease the dose received by the infant. However, these maneuvers are probably not necessary in most cases. High doses might occasionally cause temporary loss of milk supply.

Drug Levels

Maternal Levels. After oral prednisone, peak milk levels of total prednisone plus prednisolone were 28.3 mcg/L after a 10 mg oral dose in one woman;[1] 102 mcg/L after a 20 mg dose in a second;[2] and 627 mcg/L after a 120 mg dose in another.[3] Peak milk steroid levels occur about 2 hours after a dose of prednisone.[1][2][3]

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

Effects in Breastfed Infants

None reported with prednisone or any other corticosteroid. In a prospective follow-up study, six nursing mothers reported taking prednisone (dosage unspecified) with no adverse infant effects.[4] There are several reports of mothers breastfeeding during long-term use of corticosteroids with no adverse infant effects: prednisone 10 mg daily (2 infants)[5][6] and prednisolone 5 to 7.5 mg daily (14 infants).[7]

A woman with Crohn's disease used prednisone 60 mg/day in a tapering schedule immediately postpartum during breastfeeding (extent not stated). She also received sulfasalazine 4 g/day and infliximab 5 mg/kg every 8 weeks during pregnancy and postpartum. At 6 months of age, the infant was asymptomatic with regular weight gain.[8]

Possible Effects on Lactation

Published information on the effects of prednisone 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.[9][10]

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.[11] An equivalent dosage regimen of prednisone 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.[12] An equivalent dosage regimen of prednisone might have the same effect.

Alternate Drugs to Consider

Methylprednisolone, Prednisolone

References

1. Katz FH, Duncan BR. Entry of prednisone into human milk. N Engl J Med. 1975;293:1154. Letter. PMID: 1186783

2. Sagraves R, Kaiser D, Sharpe GL. Prednisone and prednisolone concentrations in the milk of a lactating mother. Drug Intell Clin Pharm. 1981;15:484. Abstract.

3. Berlin Jr CM, Kaiser DG, Demers L. Excretion of prednisone and prednisolone in human milk. Pharmacologist. 1979;21:264. Abstract.

4. Ito S, Blajchman A, Stephenson M et al. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993;168:1393-9. PMID: 8498418

5. Moretti ME, Sgro M, Johnson DW et al. Cyclosporine excretion into breast milk. Transplantation. 2003;75:2144-6. PMID: 12829927

6. Munoz-Flores-Thiagarajan KD, Easterling T, Davis C et al. Breast-feeding by a cyclosporine-treated mother. Obstet Gynecol. 2001;97(5 pt 2):816-8. PMID: 11336764

7. Nyberg G, Haljamae U, Frisenette-Fich C et al. Breast-feeding during treatment with cyclosporine. Transplantation. 1998;65:253-5. PMID: 9458024

8. Correia LM, Bonilha DQ, Ramos JD et al. Inflammatory bowel disease and pregnancy: report of two cases treated with infliximab and a review of the literature. Eur J Gastroenterol Hepatol. 2010;22:1260-4. PMID: 20671559

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

10. 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

11. 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

12. 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

Prednisone Identification

Substance Name

Prednisone

CAS Registry Number

53-03-2

Drug Class

Administrative Information

LactMed Record Number

224

Information from the National Library of Medicine's LactMed Database.

Last Revision Date

2013-12-06

Disclaimer

Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

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