Hydrocortisone use while Breastfeeding
Drugs containing Hydrocortisone: Hydrocortone, Hydrocortisone 1% In Absorbase, Cortisporin Otic, Proctozone HC, Proctosol-HC, Anusol-HC, Hydrocortisone with Aloe, Cortef, Cortisporin-TC, Analpram-HC, Show all 242 »Westcort, Anucort-HC, Locoid, Solu-Cortef, Proctofoam HC, Proctocort, Analpram E, Anusol-HC Suppositories, Cortizone-10, Proctocream-HC, Procto-Med HC, Cortaid, Alcortin A, Colocort, Hydrocort cream, Cortisporin Ophthalmic Suspension, Alcortin, Vytone, Hytone, Cipro HC, Acetasol HC, Xerese, Pramosone, Pramcort, Coly-Mycin S, Cortenema, Epifoam, Ala-Quin, Vosol HC, AnaMantle HC, Locoid Lipocream, Cortizone-5, Aeroseb-HC, Ala-Cort, Hemorrhoidal HC, ProctoCare-HC, Hemmorex-HC, Scalpicin, HC Pramoxine, Novacort, Antibiotic Ear, Cortifoam, Pandel, Genasone/Aloe, Blue-Emu Anti-Itch Cream, Enzone, Cort-Dome High Potency, Coraz, Procto-Pak 1%, Preparation H Anti-Itch Cream Hydrocortisone 1%, Dermazene, Ana-Lex, Lidocort, Earsol-HC, Ketocon+Plus, Lidazone HC, LidaMantle HC, Nutracort, Scalp-Cort, Instacort, Scalacort, Delcort, Caldecort, Anusol HC-1, Aloe Cort, Penecort, Rectasol-HC, Cetacort, Texacort, Cortisporin Cream, Pramox-HC, Hydrocortone Phosphate, Pediotic, Cortomycin, IvDerm, Analpram Advanced, Exotic-HC, Otomar HC, Dek-Quin, Cortane-B, Triple Antibiotic HC Ophthalmic Ointment, Zypram, Procort, Zone-A, Cortaid Maximum Strength, Dermarest Eczema Medicated, NuCort with Aloe, Gynecort Maximum Strength, Cortalo with Aloe, Aqua Glycolic HC, NuZon, Tucks Hydrocortisone Anti-Itch Ointment, Monistat Soothing Care Itch Relief Cream, Cort-Biotic, Encort, Cortaid Intensive Therapy, Pramosone E, U-Cort, MiCort-HC, Proctosert HC, Proctozone-H, Cortatrigen, Hemril-30, Cortizone-10 Plus, Anuzone HC, Dermtex HC, Massengill Medicated Soft Cloth, Dermarest Dricort, Neutrogena T-Scalp, Cortizone for Kids, Dermarest Plus Anti-Itch, Nupercainal HC 1%, Scalacort DK, Otobiotic, Lodocort Aloe, Masporin Otic, Bioelements Immediate Comfort, Hydropram, Rectocort HC, Zone-A Forte, HC Pram, LidaMantle HC Relief, Oti-Sone, Xyralid RC, Cortomycin Suspension, Neo/PolyB/HC, AK-Spore HC Otic Suspension, Drotic, Rectacreme HC, UAD Otic, Peranex HC, RectaGel HC, Senatec HC, AnaMantle HC Forte, Xyralid, Xyralid LP, BP Ana-Lex HC, Otocort Sterile Solution, Cortatrigen Modified, Otimar, Xolegel CorePak, Otocort Sterile Suspension, Recort Anti-Itch Cream, Anuprep-HC, Cortizone-10 Anal Itch Cream, Corque, Zolene HC, Otirx, Cortic-ND, Aero Otic HC, Cortamox, Hydro Ear, Cortane-B Lotion, Dermasorb AF, Iodo-HC, Tri-Otic, Steroform, Hysone, Vio-Tex-HC, Pedi-Cort V, 1 Plus 1 F, HC-Derma-Pax, FIRST Duke's Mouthwash, FIRST Mary's Mouthwash, Cyotic, Zoto-HC Drops, Vagisil Satin Anti-Itch Creme, Cortisporin Ophthalmic Ointment, Vasotate HC, Oticot HC, Lipsovir, Neo-Polycin HC, Cortomycin Eye Ointment, Neo-Poly-Bac, Ocu-Cort, Neotricin HC, Cortisporin Ointment, Oto-End, MyOxin, Trioxin, Bencort, Vanoxide-HC, Ophthocort, Mantadil, Oticin HC, Otozone, A-Hydrocort, Carmol HC, Ivocort, Hi-Cor, Aquanil HC, Itch-X Lotion, Corticaine, Corticreme, Pediaderm HC, Dermol HC, Dermolate, Gly-Cort, Hycort, Cortaid with Aloe, Nogenic HC, Recort Plus, Rederm, Sarnol-HC, Scalp-Aid, Cort-Dome, Instacort 10, Beta HC, Acticort 100, Anusert HC-1, MD Hydrocortisone, GRx HiCort 25, Ala-Scalp, Keratol HC, NuCort, Dermasorb HC, Rectacort-HC, Neosporin Eczema Essentials Anti-Itch Cream, Dermacort, Cortizone-10 Intensive Healing Formula, Procto-Kit 1%, Anurx-HC, Procto-Kit 2.5%, Anumed-HC, Hemril-HC Uniserts, Cotacort, Lacticare-HC, Orabase HCA, Ala-Scalp HP, Cortane, Anutone-HC, Uremol 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 in the morning at about 7:00 am and the lowest concentrations in the late afternoon and evening. Cortisol in milk may protect against later infant obesity, especially in girls. 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. 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.
Hydrocortisone concentrations in breastmilk are not affected by storage for 36 hours at room temperature, during multiple freeze-thaw cycles, nor Holder pasteurization (62.5 degrees C for 30 minutes).
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.
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.
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.
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, 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. van der Voorn B, de Waard M, Dijkstra LR et al. Stability of cortisol and cortisone in human breast milk during Holder pasteurization. J Pediatr Gastroenterol Nutr. 2017. PMID: 28691975
6. 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
7. 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
8. McGuire E. Sudden loss of milk supply following high-dose triamcinolone (Kenacort) injection. Breastfeed Rev. 2012;20:32-4. PMID: 22724311
9. 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
10. 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
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
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