Hydrocortisone use while Breastfeeding
Drugs containing Hydrocortisone: Anusol-HC, Proctozone HC, Cortisporin Otic, Proctosol-HC, Cortef, Westcort, Anucort-HC, Analpram-HC, Solu-Cortef, Cortisporin-TC, Show all 239 »Proctocort, Anusol-HC Suppositories, Cortizone-10, Pramosone, Locoid, Proctofoam HC, Cortisporin Ophthalmic Suspension, Hydrocortisone 1% In Absorbase, Cipro HC, Vytone, Hytone, Locoid Lipocream, Cortaid, Alcortin A, Coly-Mycin S, Otomar HC, Vosol HC, HC Pramoxine, Hemorrhoidal HC, Cortenema, Cortifoam, Proctocream-HC, Xerese, Proctozone-H, Scalpicin, Antibiotic Ear, Cortisporin Ophthalmic Ointment, Acetasol HC, Novacort, Cortisporin Ointment, Hydrocort cream, Aquanil HC, Dermasorb HC, Exotic-HC, Triple Antibiotic HC Ophthalmic Ointment, Analpram Advanced, Recort Plus, Encort, Cortizone-10 Anal Itch Cream, Trioxin, AnaMantle HC, Ketocon+Plus, Coraz, Alcortin, Aqua Glycolic HC, Procto-Pak 1%, Aloe Cort, Anusol HC-1, Hycort, Tucks Hydrocortisone Anti-Itch Ointment, Preparation H Anti-Itch Cream Hydrocortisone 1%, Hemmorex-HC, Hydrocortone, Oticin HC, Dermasorb AF, Cortane-B, Cortisporin Cream, Rederm, Genasone/Aloe, Pandel, Nupercainal HC 1%, Cortaid with Aloe, Cortane, Aeroseb-HC, Rectacort-HC, Hemril-HC Uniserts, Ala-Cort, Penecort, Cortizone for Kids, Colocort, Epifoam, Xyralid, Analpram E, Dermazene, Pramcort, Zypram, Ana-Lex, Senatec HC, Otocort Sterile Solution, Hydrocortisone with Aloe, Drotic, Cortamox, LidaMantle HC, Earsol-HC, Hemril-30, ProctoCare-HC, Zoto-HC Drops, Neo-Polycin HC, Vanoxide-HC, Procort, Cyotic, Lipsovir, Cortane-B Lotion, Dek-Quin, Ala-Quin, Cortic-ND, Nutracort, Cortatrigen Modified, Rectocort HC, Instacort, Monistat Soothing Care Itch Relief Cream, Masporin Otic, Enzone, Zone-A Forte, Zone-A, Cortalo with Aloe, Lodocort Aloe, Xolegel CorePak, Dermarest Eczema Medicated, Proctosert HC, U-Cort, Cortizone-10 Plus, Anuzone HC, Dermtex HC, Cortaid Maximum Strength, Cortaid Intensive Therapy, Gynecort Maximum Strength, Massengill Medicated Soft Cloth, Hydropram, Procto-Med HC, NuZon, NuCort with Aloe, AnaMantle HC Forte, AK-Spore HC Otic Suspension, Pediotic, Cortomycin, Otimar, Scalacort DK, Dermarest Dricort, Otocort Sterile Suspension, Oti-Sone, Otobiotic, Cort-Biotic, Cortatrigen, UAD Otic, Neo/PolyB/HC, Cortomycin Suspension, RectaGel HC, Peranex HC, Lidazone HC, Xyralid LP, BP Ana-Lex HC, Rectacreme HC, LidaMantle HC Relief, Uremol HC, HC Pram, Xyralid RC, Lidocort, Pramosone E, Dermacort, 1 Plus 1 F, HC-Derma-Pax, FIRST Duke's Mouthwash, Pedi-Cort V, Vio-Tex-HC, Iodo-HC, Steroform, Hysone, FIRST Mary's Mouthwash, Hydrocortone Phosphate, Keratol HC, NuCort, Cort-Dome High Potency, Ala-Scalp, MD Hydrocortisone, A-Hydrocort, Vagisil Satin Anti-Itch Creme, Carmol HC, Corque, Pramox-HC, Neotricin HC, MyOxin, Bencort, Ocu-Cort, Neo-Poly-Bac, Vasotate HC, Oticot HC, Cortomycin Eye Ointment, Ophthocort, Mantadil, Aero Otic HC, IvDerm, Hydro Ear, Otirx, Zolene HC, Otozone, Oto-End, Tri-Otic, Cetacort, Cortizone-10 Intensive Healing Formula, Gly-Cort, Hi-Cor, Nogenic HC, Scalacort, Dermolate, Delcort, Pediaderm HC, Dermol HC, Sarnol-HC, Scalp-Aid, Bioelements Immediate Comfort, Dermarest Plus Anti-Itch, Cortizone-5, Ivocort, Beta HC, Cort-Dome, Instacort 10, Scalp-Cort, Corticreme, Corticaine, Rectasol-HC, Anumed-HC, Cotacort, Anuprep-HC, Procto-Kit 2.5%, Texacort, GRx HiCort 25, Procto-Kit 1%, Lacticare-HC, Orabase HCA, Blue-Emu Anti-Itch Cream, Caldecort, Itch-X Lotion, Acticort 100, Anusert HC-1, Ala-Scalp HP, Anutone-HC, Anurx-HC, Neutrogena T-Scalp
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. 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.
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. 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, 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
2. 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
3. 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
4. McGuire E . Sudden loss of milk supply following high-dose triamcinolone (Kenacort) injection. Breastfeed Rev. 2012;20:32-4. PMID: 22724311
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. 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
7. 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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