Prednisone and Breastfeeding

Summary of use during lactation

Amounts of prednisone in breastmilk are very low. No adverse effect have been reported in breastfed infants with maternal use of any corticosteroid during breastfeeding. Although it is often recommended to avoid breastfeeding for 4 hours after a dose this maneuver is not necessary because prednisone milk levels are very low. Medium to large doses of corticosteroids given systemically or injected into joints or the breast have been reported to cause temporary reduction of lactation.

Drug levels in milk and infant serum

Maternal Levels. After oral prednisone, peak milk levels of total prednisone plus prednisolone were 28.3 mcg/L after a 10 mg oral dose in one woman;[1] 102 mcg/L after a 20 mg dose in a second;[2] and 627 mcg/L after a 120 mg dose in another.[3] Peak milk steroid levels occur about 2 hours after a dose of prednisone. Two women taking oral prednisone provided milk by complete breast emptying using a breast pump every 2 to 3 hours over one dosage interval. One subject was taking a dose of 2 mg every 12 hours and the other was taking 15 mg every 24 hours. The respective infant weight-adjusted dosages were 0.58% and 0.35% of the maternal dose for prednisone and 0.18% and 0.09% for prednisolone. Drug concentrations in milk were undetectable (<4 mcg/L) after 12 hours for prednisone and 6 hours for prednisolone.[4] Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

None reported with prednisone or any other corticosteroid. In a prospective follow-up study, six nursing mothers reported taking prednisone (dosage unspecified) with no adverse infant effects.[5] There are several reports of mothers breastfeeding during long-term use of corticosteroids with no adverse infant effects: prednisone 10 mg daily (2 infants) and prednisolone 5 to 7.5 mg daily (14 infants).[6-8] A woman with Crohn's disease used prednisone 60 mg daily in a tapering schedule immediately postpartum during breastfeeding (extent not stated). She also received sulfasalazine 4 grams daily and infliximab 5 mg/kg every 8 weeks during pregnancy and postpartum. At 6 months of age, the infant was asymptomatic with regular weight gain.[9] The National Transplantation Pregnancy Registry reports that as of December 2013, 124 women with transplants have taken prednisone while breastfeeding 169 infants for periods as long as 48 months, with no apparent infant harm.[10]

Effects on lactation and breastmilk

Published information on the effects of prednisone on serum prolactin or on lactation in nursing mothers was not found as of the revision date. Medium to large doses of corticosteroids given systemically or injected into joints or the breast have been reported to cause temporary reduction of lactation.[11-15] 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.[16] An equivalent dosage regimen of prednisone 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.[17] An equivalent dosage regimen of prednisone might have the same effect.

Alternative drugs to consider

Methylprednisolone, Prednisolone

References

1. Katz FH, Duncan BR. Entry of prednisone into human milk. N Engl J Med 1975;293:1154.1186783 PubMed
2. Sagraves R, Kaiser D, Sharpe GL. Prednisone and prednisolone concentrations in the milk of a lactating mother. Drug Intell Clin Pharm 1981;15:484.
3. Berlin CM, Jr, Kaiser DG, Demers L. Excretion of prednisone and prednisolone in human milk. Pharmacologist 1979;21:264.
4. Ryu RJ, Easterling TR, Caritis SN, et al. Prednisone pharmacokinetics during pregnancy and lactation. J Clin Pharmacol 2018;58:1223-32.29733485 PubMed
5. Ito S, Blajchman A, Stephenson M, et al. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol 1993;168:1393-9.8498418 PubMed
6. Moretti ME, Sgro M, Johnson DW, et al. Cyclosporine excretion into breast milk. Transplantation 2003;75:2144-6.12829927 PubMed
7. Muñoz-Flores-Thiagarajan KD, Easterling T, Davis C, Bond EF. Breast-feeding by a cyclosporine-treated mother. Obstet Gynecol 2001;97:816-8.11336764 PubMed
8. Nyberg G, Haljamae U, Frisenette-Fich C, et al. Breast-feeding during treatment with cyclosporine. Transplantation 1998;65:253-5.9458024 PubMed
9. Correia LM, Bonilha DQ, Ramos JD, et al. Inflammatory bowel disease and pregnancy: Report of two cases treated with infliximab and a review of the literature. Eur J Gastroenterol Hepatol 2010;22:1260-4.20671559 PubMed
10. Constantinescu S, Pai A, Coscia LA, et al. Breast-feeding after transplantation. Best Pract Res Clin Obstet Gynaecol 2014;28:1163-73.25271063 PubMed
11. McGuire E. Sudden loss of milk supply following high-dose triamcinolone (Kenacort) injection. Breastfeed Rev 2012;20:32-4.22724311 PubMed
12. Babwah TJ, Nunes P, Maharaj RG. An unexpected temporary suppression of lactation after a local corticosteroid injection for tenosynovitis. Eur J Gen Pract 2013;19:248-50.24261425 PubMed
13. 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;15:171-6.27172081 PubMed
14. Das N, Dave S, Dangaich R, et al. Lactation failure following therapeutic steroid treatment in a mother with postpartum depression and spinal-dural arteriovenous fistula: Case report and literature review. Int J Gynaecol Obstet 2024;165:389-91.38093554 PubMed
15. Rosen-Carole C, Datta P, Palmiter K, et al. Transfer of injected triamcinolone into human milk of a lactating patient suffering from idiopathic granulomatous mastitis. Breastfeed Med 2023;18:74-7.36638194 PubMed
16. Henderson JJ, Hartmann PE, Newnham JP, Simmer K. Effect of preterm birth and antenatal corticosteroid treatment on lactogenesis II in women. Pediatrics 2008;121:e92-100.18166549 PubMed
17. 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;4:201-6.19772378 PubMed