Methylprednisolone use while Breastfeeding
Drugs containing Methylprednisolone: Medrol, Medrol Dosepak, Solu-Medrol, MethylPREDNISolone Dose Pack, Depo-Medrol, Methylpred DP, Medralone 40, Methylcotol, A-Methapred, Med-Jec-40, Show all 26 »M-Prednisolone, Predacorten, Methacort 40, Medralone 80, Methylcotolone, Methacort 80, Hybrisil, Adlone-40, Depoject-80, Dep Medalone 80, Depopred, Adlone-80, Depmedalone, Medipred, Duralone, Medralone
Methylprednisolone Levels and Effects while Breastfeeding
Summary of Use during Lactation
Amounts of methylprednisolone in breastmilk are very low. No adverse effect have been reported in breastfed infants with maternal use of any corticosteroid during breastfeeding. With high intravenous maternal doses of methylprednisolone, such as 1 gram for multiple sclerosis relapse, fully breastfed infants would receive doses nearing their daily cortisol output, but less than a therapeutic dose, on the day of infusion. Avoiding breastfeeding during the infusion and for 2 to 8 hours after a 1 gram dose is recommended by various sources. Local 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.
Maternal Levels. In one woman taking 6 mg daily of methylprednisolone by mouth, 2 peak milk levels occurred: one at 2 hours after the dose and another 8 hours after the dose. Peaks were about 7 mcg/L, while levels fell to about 2.5 mcg/L 6 hours after the dose and to about 1 mcg/L 10 hours after the dose.
A woman with multiple sclerosis had a relapse in the first 3 months postpartum. She was given methylprednisolone 1 gram daily for 3 days. Milk samples were obtained after one of the doses. The breastmilk methylprednisolone was 3 mg/L immediately after the dose and 1.2 mg/L at 4 hours after the dose. The authors estimated that an infant who nurses at 4 hours after a dose will ingest 0.168 mg of methylprednisolone which is equivalent of 0.84 mg of cortisol or 42% of the daily output. An infant who nurses starting at 8 hours after a dose will ingest 0.048 mg of methylprednisolone which is equivalent to 12% of daily cortisol production. The authors did not specify their method of calculating these values.
A woman with multiple sclerosis who was 5 months postpartum received 1 gram of methylprednisolone infused intravenously over 2 hours on 3 successive days. She provided milk samples at 0, 1, 2, 4, 8 and 12 hours after each dose. Breastmilk levels at 0 and 12 hours were not quantifiable (<0.06 mg/L). Peak levels occurred at 1 hour after the end of the infusion and averaged 5.3 mg/L (range 5.1 to 5.6 mg/L). By 4 hours, after the dose, milk levels averaged 1.1 mg/L (range 1.0 to 1.6 mg/L) and by 8 hours, milk levels averaged 0.27 mg/L (range 0.2 to 0.37 mg/L). The authors calculated that a fully breastfed infant would have received an average of 0.19 mg/kg daily (range 0.16 to 0.21 mg/kg daily) of methylprednisolone, which is less than the lowest recommended therapeutic dose for infants. Withholding nursing for 2 to 4 hours after a dose would reduce the dose substantially.
A woman who was nursing a 9-month-old infant was given 1 gram of methylprednisolone daily for 3 days to treat multiple sclerosis. Cortisol milk levels were measured in breastmilk because of a lack of a methylprednisolone assay. By the fourth hour after the last dose, the cortisol concentration in breastmilk was approximately equal to the endogenous production of cortisol in an infant. The authors considered that waiting 4 hours after a 1 gram dose of methylprednisolone before resuming breastfeeding to be adequate.
Infant Levels. Relevant published information was not found as of the revision date.
Effects in Breastfed Infants
None reported with methylprednisolone or any other corticosteroid. None reported with methylprednisolone or any other corticosteroid. Three infants were breastfed from birth during maternal use of methylprednisolone 6 to 8 mg daily with no reported adverse effects up to 3 months. In one of the papers, 2 infants had normal blood cell counts, no increase in infections and above average growth rates.
Effects on Lactation and Breastmilk
A patient who was 6 weeks postpartum and predominantly breastfeeding her infant received 24 mg of depot methylprednisolone plus 15 mg of A patient who was 6 weeks postpartum and predominantly breastfeeding her infant received 24 mg of depot methylprednisolone plus 15 mg of lidocaine intralesionally for tenosynovitis of the wrist. Thirty hours after the injection, lactation ceased. Her breasts were soft and not engorged at that time. Thirty-six hours later, lactation resumed slowly, reaching normal milk production 24 hours later. The author hypothesized that the suppression might have occurred because the injection was in a highly mobile joint, which might have caused rapid release of the corticosteroid. A large dose of triamcinolone injected into the shoulder has also been reported to cause temporary cessation 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 methylprednisolone 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 methylprednisolone might have the same effect.
Alternate Drugs to Consider
1. Bodiguel E, Bensa C, Brassat D et al. [Multiple sclerosis and pregnancy]. Rev Neurol (Paris). 2014;170:247-65. PMID: 24684929
2. Strijbos E, Coenradie S, Touw D, Aerden L. High-dose methylprednisolone for multiple sclerosis during lactation: Concentrations in breast milk. Mult Scler. 2015;21:797-8. PMID: 25583837
3. Cooper SD, Felkins K, Baker TE, Hale TW. Transfer of methylprednisolone into breast milk in a mother with multiple sclerosis. J Hum Lact. 2015;31:237-9. PMID: 25691380
4. Gunduz S, Gencler OS, Celik HT. Four hours is enough for lactation interruption after high-dose methylprednisolone treatment in multiple sclerosis mothers by measuring milk cortisol levels. J Matern Fetal Neonatal Med. 2016;29:3495. PMID: 26755401
5. Coulam CB, Moyer TP, Jiang NS et al. Breast-feeding after renal transplantation. Transplant Proc. 1982;13:605-9. PMID: 6817481
6. Grekas DM, Vasiliou SS, Lazarides AN. Immunosuppresive therapy and breast-feeding after renal transplantation. Nephron. 1984;37:68. Letter. PMID: 6371564
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. McGuire E . Sudden loss of milk supply following high-dose triamcinolone (Kenacort) injection. Breastfeed Rev. 2012;20:32-4. PMID: 22724311
9. 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
10. 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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