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Hydrocortisone use while Breastfeeding

Drugs containing Hydrocortisone: Hydrocortone, Anusol-HC, Hydrocortisone 1% In Absorbase, Proctozone HC, Cortisporin Otic, Hydrocortisone with Aloe, Proctosol-HC, Cortef, Anucort-HC, Analpram-HC, Show all 241 »Westcort, Cortisporin-TC, Proctofoam HC, Proctocort, Solu-Cortef, Cortizone-10, Hytone, Locoid, Pramosone, Alcortin, Cortisporin Ophthalmic Suspension, Anusol-HC Suppositories, Acetasol HC, Cortaid, Cipro HC, Vytone, Alcortin A, Cortisporin Cream, Cortifoam, Hydrocort cream, Pandel, Cortizone-5, Vosol HC, Xerese, Proctocream-HC, Hemorrhoidal HC, Procto-Med HC, Cortenema, Genasone/Aloe, Colocort, Cortizone-10 Anal Itch Cream, Procto-Pak 1%, AnaMantle HC, Ala-Quin, HC Pramoxine, Ketocon+Plus, Lidocort, Cortisporin Ophthalmic Ointment, Nutracort, Scalpicin, Lacticare-HC, Locoid Lipocream, Preparation H Anti-Itch Cream Hydrocortisone 1%, ProctoCare-HC, Hemmorex-HC, Proctozone-H, Antibiotic Ear, Pediotic, Pramcort, Procort, Analpram E, Anumed-HC, Ala-Cort, Anuprep-HC, Aloe Cort, Blue-Emu Anti-Itch Cream, Dermasorb HC, MD Hydrocortisone, Epifoam, Keratol HC, NuCort, Aquanil HC, Texacort, Gly-Cort, Peranex HC, Earsol-HC, Oticin HC, IvDerm, Dermazene, Instacort, Encort, Recort Plus, Pramox-HC, Instacort 10, Beta HC, Nupercainal HC 1%, Dermolate, Anusol HC-1, Coraz, Cortomycin, Cortisporin Ointment, Neo-Polycin HC, Vanoxide-HC, NuZon, NuCort with Aloe, Gynecort Maximum Strength, Dermarest Eczema Medicated, Cortalo with Aloe, Zone-A, Xolegel CorePak, Cortomycin Suspension, Xyralid RC, Lodocort Aloe, Monistat Soothing Care Itch Relief Cream, Enzone, Aqua Glycolic HC, Tucks Hydrocortisone Anti-Itch Ointment, Neutrogena T-Scalp, Dermarest Dricort, Massengill Medicated Soft Cloth, Cortizone for Kids, Dermarest Plus Anti-Itch, Bioelements Immediate Comfort, Recort Anti-Itch Cream, Dermtex HC, Anuzone HC, Cortaid Maximum Strength, Cortaid Intensive Therapy, U-Cort, Proctosert HC, Cortizone-10 Plus, Hemril-30, Rectacreme HC, Xyralid, AK-Spore HC Otic Suspension, Drotic, Masporin Otic, Ivocort, Uremol HC, HC Pram, Scalacort DK, Otocort Sterile Solution, Cortatrigen Modified, Cortatrigen, Otocort Sterile Suspension, Cort-Biotic, Oti-Sone, Otimar, Otobiotic, LidaMantle HC Relief, Zypram, Lidazone HC, AnaMantle HC Forte, Ana-Lex, LidaMantle HC, Xyralid LP, UAD Otic, Senatec HC, RectaGel HC, Pramosone E, Neo/PolyB/HC, Hydropram, Novacort, Zone-A Forte, Rectocort HC, BP Ana-Lex HC, Cort-Dome High Potency, Hydro Ear, Cortane-B Lotion, Dermasorb AF, Corque, Cortamox, Aero Otic HC, Zolene HC, Otirx, Cortic-ND, Iodo-HC, Steroform, Coly-Mycin S, Analpram Advanced, HC-Derma-Pax, FIRST Duke's Mouthwash, 1 Plus 1 F, Pedi-Cort V, Dek-Quin, Hysone, Vio-Tex-HC, Cyotic, Exotic-HC, Triple Antibiotic HC Ophthalmic Ointment, Ocu-Cort, Neotricin HC, MyOxin, Neo-Poly-Bac, Cortomycin Eye Ointment, Vasotate HC, Oticot HC, Lipsovir, Trioxin, Bencort, Zoto-HC Drops, Tri-Otic, Otomar HC, Oto-End, Otozone, Ophthocort, Mantadil, Cortane-B, FIRST Mary's Mouthwash, Hydrocortone Phosphate, Itch-X Lotion, Corticaine, Corticreme, Delcort, Caldecort, Acticort 100, Anurx-HC, Anusert HC-1, Cortaid with Aloe, Pediaderm HC, Dermol HC, Sarnol-HC, Scalp-Aid, Cort-Dome, Rederm, Nogenic HC, Scalacort, Hi-Cor, Hycort, Anutone-HC, Cortane, Neosporin Eczema Essentials Anti-Itch Cream, Cetacort, Dermacort, Cortizone-10 Intensive Healing Formula, Rectacort-HC, Ala-Scalp, A-Hydrocort, Vagisil Satin Anti-Itch Creme, Carmol HC, Aeroseb-HC, GRx HiCort 25, Cotacort, Orabase HCA, Ala-Scalp HP, Penecort, Hemril-HC Uniserts, Procto-Kit 1%, Procto-Kit 2.5%, Rectasol-HC, Scalp-Cort

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. Concentrations follow a diurnal rhythm, with the highest concentrations in the morning at about 7:00 am and the lowest concentrations in the late afternoon and evening.[1][2] Cortisol in milk may protect against later infant obesity, especially in girls.[3] 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.[4]

Although it is unlikely that dangerous amounts of hydrocortisone would reach the infant, a better studied alternate corticosteroid might be preferred. Maternal use of hydrocortisone as an enema would not be expected to cause any adverse effects in breastfed infants. Local maternal 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

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.[4]

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).[5]

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.[6]

Thirteen full-term mothers donated milk between 8 and 28 weeks postpartum. Unconjugated cortisol concentrations ranged from 1.45 to 8.34 mcg/L.[4]

A study compared 10 mothers who delivered preterm (<32 week) infants to 10 who delivered at 37 weeks or greater. Breastmilk cortisol concentrations were 50% lower in mothers of preterm infants in the first week postpartum, although the difference was not statistically significant.[1]

A study of 23 mothers found that the average cortisol concentration in breastmilk was 1.6 mcg/L over 24 hours. Concentrations were highest in the morning between 4:00 am and 10:00 am and lowest in the evening between 4:00 pm to 10:00 pm.[2]

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.[7][8][9]

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.[10] 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.[11] An equivalent dosage regimen of hydrocortisone might have the same effect.

Alternate Drugs to Consider

(Systemic) Methylprednisolone, Prednisolone, Prednisone

References

1. van der Voorn B, de Waard M, van Goudoever JB et al. Breast-milk cortisol and cortisone concentrations follow the diurnal rhythm of maternal hypothalamus-pituitary-adrenal axis activity. J Nutr. 2016;146:2174-79. PMID: 27629575

2. Pundir S, Wall CR, Mitchell CJ et al. Variation of human milk clucocorticoids over 24 hour period. J Mammary Gland Biol Neoplasia. 2017;22:85-92. PMID: 28144768

3. Hahn-Holbrook J, Le TB, Chung A et al. Cortisol in human milk predicts child BMI. Obesity (Silver Spring). 2016;24:2471-74. PMID: 27891832

4. 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

5. 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

6. 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

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

8. 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

9. Smuin DM, Seidenberg PH, Sirlin EA et al. Rare adverse events associated with corticosteroid injections: A case series and literature review. Curr Sports Med Rep. 2016;15:171-6. PMID: 27172081

10. 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

11. 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

20170411

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