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