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Hydrocortisone use while Breastfeeding

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

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 at about 7:00 am.[1] Cortisol in milk may protect against later infant obesity, especially in girls.[2] 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.[3]

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.[3]

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).[4]

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.[5]

Thirteen full-term mothers donated milk between 8 and 28 weeks postpartum. Unconjugated cortisol concentrations ranged from 1.45 to 8.34 mcg/L.[3]

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]

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.[6][7]

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.[8] 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.[9] 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. 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

3. 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

4. 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

5. 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

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

7. 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

8. 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

9. 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

20161207

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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