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Hydrocortisone use while Breastfeeding

Drugs containing Hydrocortisone: Hydrocortone, Cortisporin Otic, Anusol-HC, Proctosol-HC, Cortef, Hydrocortisone 1% In Absorbase, Proctozone HC, Solu-Cortef, Anucort-HC, Analpram-HC, Show all 243 »Cortisporin-TC, Cipro HC, Proctofoam HC, Anusol-HC Suppositories, Westcort, Vosol HC, Proctocort, Preparation H Anti-Itch Cream Hydrocortisone 1%, Cortizone-10, Cortisporin Ophthalmic Suspension, Ala-Cort, Locoid, Alcortin, Hydrocortisone with Aloe, Cortizone-10 Anal Itch Cream, Proctocream-HC, Hytone, Encort, Coly-Mycin S, Alcortin A, Pramosone, Cortaid, Pediotic, Procort, Oticin HC, Hemorrhoidal HC, Otomar HC, Cortisporin Cream, Acetasol HC, Dermazene, Epifoam, Analpram E, Neosporin Eczema Essentials Anti-Itch Cream, Hydrocort cream, Cortizone-5, Tucks Hydrocortisone Anti-Itch Ointment, Xerese, Procto-Med HC, Cortifoam, Novacort, Corticaine, Tri-Otic, Locoid Lipocream, Anusol HC-1, Otozone, Oto-End, Zolene HC, Dermacort, Cortizone-10 Intensive Healing Formula, Texacort, Rectasol-HC, Lacticare-HC, Aquanil HC, Ala-Quin, Genasone/Aloe, Pandel, Dermarest Plus Anti-Itch, Cortizone for Kids, Cortatrigen, Proctozone-H, MiCort-HC, U-Cort, Nutracort, LidaMantle HC, Dermasorb AF, AnaMantle HC, Pramcort, Analpram Advanced, Colocort, HC Pramoxine, Rectocort HC, NuCort with Aloe, Neutrogena T-Scalp, Nupercainal HC 1%, Bioelements Immediate Comfort, Recort Anti-Itch Cream, Massengill Medicated Soft Cloth, Ivocort, Vytone, Lodocort Aloe, Ketocon+Plus, Xolegel CorePak, Dermarest Dricort, Dermtex HC, Procto-Pak 1%, Instacort, Dermarest Eczema Medicated, Cortalo with Aloe, Aqua Glycolic HC, BP Ana-Lex HC, Monistat Soothing Care Itch Relief Cream, Hemmorex-HC, Scalpicin, Anuzone HC, Gynecort Maximum Strength, NuZon, Cortaid Intensive Therapy, Cortaid Maximum Strength, Proctosert HC, Hemril-30, Cortizone-10 Plus, ProctoCare-HC, Neo/PolyB/HC, Xyralid LP, Zypram, Drotic, Hydropram, AK-Spore HC Otic Suspension, Zone-A Forte, Enzone, Zone-A, HC Pram, Scalacort DK, Rectacreme HC, LidaMantle HC Relief, Lidocort, Casporyn HC, Xyralid RC, Cortomycin, Cortomycin Suspension, Pramosone E, Scalp-Cort, Xyralid, Oti-Sone, Ana-Lex, Lidazone HC, AnaMantle HC Forte, Senatec HC, RectaGel HC, Peranex HC, Otobiotic, Cort-Biotic, Coraz, Antibiotic Ear, UAD Otic, Otocort Sterile Suspension, Otimar, Cortatrigen Modified, Otocort Sterile Solution, Masporin Otic, Beta HC, Anumed-HC, Instacort 10, Iodo-HC, Cortic-ND, Aero Otic HC, IvDerm, Cortamox, Hydro Ear, Pramox-HC, Cortane-B Lotion, Corque, Steroform, Cyotic, Dek-Quin, Hysone, Vio-Tex-HC, Pedi-Cort V, 1 Plus 1 F, HC-Derma-Pax, FIRST Duke's Mouthwash, FIRST Mary's Mouthwash, Hydrocortone Phosphate, Otirx, Exotic-HC, Cortenema, Ocu-Cort, Vasotate HC, Earsol-HC, Oticot HC, Lipsovir, Neo-Polycin HC, Cortomycin Eye Ointment, Neo-Poly-Bac, Triple Antibiotic HC Ophthalmic Ointment, Neotricin HC, Zoto-HC Drops, Cortisporin Ophthalmic Ointment, Cortisporin Ointment, MyOxin, Trioxin, Bencort, Vanoxide-HC, Ophthocort, Mantadil, Cortane-B, A-Hydrocort, Carmol HC, Cort-Dome, Dermol HC, Acticort 100, Aloe Cort, Blue-Emu Anti-Itch Cream, Caldecort, Itch-X Lotion, Corticreme, Delcort, Pediaderm HC, Dermolate, Anusert HC-1, Scalacort, Gly-Cort, Hi-Cor, Hycort, Nogenic HC, Recort Plus, Rederm, Sarnol-HC, Scalp-Aid, Cortaid with Aloe, Anurx-HC, MD Hydrocortisone, Aeroseb-HC, Ala-Scalp, Keratol HC, NuCort, Dermasorb HC, Rectacort-HC, Vagisil Anti-Itch Creme Sensitive Skin Formula, Cort-Dome High Potency, Cetacort, GRx HiCort 25, Anutone-HC, Procto-Kit 1%, Procto-Kit 2.5%, Anuprep-HC, Hemril-HC Uniserts, Penecort, Cotacort, Orabase HCA, Ala-Scalp HP, Cortane, Uremol HC

Medically reviewed on Jan 30, 2018

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 and might have a role in intestinal maturation, the intestinal microbiome, growth, body composition or neurodevelopment, but adequate studies are lacking.[1] 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.[2][3] Cortisol in milk may protect against later infant obesity, especially in girls.[4] 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.[5]

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).[5][6]

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.[5]

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).[7]

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.[8]

Thirteen full-term mothers donated milk between 8 and 28 weeks postpartum. Unconjugated cortisol concentrations ranged from 1.45 to 8.34 mcg/L.[5]

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.[2]

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.[3]

Cortisol was measured in the breastmilk of 22 women who delivered preterm infants between 28 and 32 weeks of gestation. The average cortisol concentration in breastmilk was 4.48 mcg/L with considerable variation. Mothers who gave birth before 30 weeks of gestation had an average cortisol concentration of 1.61 mcg/L and those who delivered after 30 weeks had an average concentration of 2.16 mcg/L.[9]

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.[10][11][12]

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.[13] 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.[14] An equivalent dosage regimen of hydrocortisone might have the same effect.

Alternate Drugs to Consider

(Systemic) Methylprednisolone, Prednisolone, Prednisone

References

1. Hollanders JJ, Heijboer AC, van der Voorn B et al. Nutritional programming by glucocorticoids in breast milk: Targets, mechanisms and possible implications. Best Pract Res Clin Endocrinol Metab. 2017. DOI: doi:10.1016/j.beem.2017.10.001

2. 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

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

4. 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

5. 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

6. 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;6:658-60. PMID: 28691975

7. 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

8. 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

9. Pundir S, Mitchell CJ, Thorstensen EB et al. Impact of preterm birth on glucocorticoid variability in human milk. J Hum Lact. 2017;34:130-6. PMID: 28903014

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

11. 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

12. 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

13. 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

14. 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

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.

Further information

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