Is Methylprednisolone compatible with breastfeeding? Do we have alternatives for Methylprednisolone?

Methylprednisolone

July 31, 2016 (Very Low Risk)

Excreted into breast milk in non-significant amount with no problems reported in breastfed infants whose mothers were treated at a daily dose as high as 8 mg for a long time period.

On long term treatments it would be advisable to wait for 2 - 4 hours until the next nurse to minimize the transfer of drug to breast milk. By waiting for 2 a 4 hours after a methylprednisolone megadose or a pulse therapy dose, the transfer into breast milk may be minimized as well.

At high doses, intra-articular treatment with other steroid drugs (Triamcinolone) have transiently affected milk production. Steroids administered before delivery may delay initiation of phase II of Lactogenesis ("milk come in") and decrease milk production in the first postpartum week.

Decreased production has been seen while taking Dexametasone.

Steroid drugs are commonly used for Pediatric treatment with no side effects when infrequently used and for short-time periods.

The American Academy of Pediatrics rates it compatible with breastfeeding.

WHO Model List of Essential Medicines (2002) rates it compatible with breastfeeding

Alternatives

We do not have alternatives for Methylprednisolone since it is relatively safe.

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • Methylprednisolone Acetate
  • Methylprednisolone Hydrogen Succinate
  • Methylprednisolone Sodium Succinate

Writings

  • Метилпреднизолон (Cyrillic)
  • 甲泼尼龙 (Chinese)
  • メチルプレドニゾロン (Japanese)
  • C22H30O5 (Molecular formula)

References

  1. Flint J, Panchal S, Hurrell A, van de Venne M, Gayed M, Schreiber K, Arthanari S, Cunningham J, Flanders L, Moore L, Crossley A, Purushotham N, Desai A, Piper M, Nisar M, Khamashta M, Williams D, Gordon C, Giles I; BSR and BHPR Standards, Guidelines and Audit Working Group. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford). 2016Abstract Full text (link to original source) Full text (in our servers)
  2. 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. 2016Abstract
  3. Almas S, Vance J, Baker T, Hale T. Management of Multiple Sclerosis in the Breastfeeding Mother. Mult Scler Int. 2016Abstract Full text (link to original source) Full text (in our servers)
  4. Strijbos E, Coenradie S, Touw DJ, Aerden L. High-dose methylprednisolone for multiple sclerosis during lactation: Concentrations in breast milk. Mult Scler. 2015Abstract
  5. Cooper SD, Felkins K, Baker TE, Hale TW. Transfer of methylprednisolone into breast milk in a mother with multiple sclerosis. J Hum Lact. 2015Abstract
  6. Bodiguel E, Bensa C, Brassat D, Laplaud D, Le Page E, Ouallet JC, Zephir H, De Seze J; Groupe de Réflexion sur la Sclérose en Plaques. Multiple sclerosis and pregnancy. Rev Neurol (Paris). 2014Abstract
  7. Babwah TJ, Nunes P, Maharaj RG. An unexpected temporary suppression of lactation after a local corticosteroid injection for tenosynovitis. Eur J Gen Pract. 2013Abstract
  8. Bae YS, Van Voorhees AS, Hsu S, Korman NJ, Lebwohl MG, Young M, Bebo B Jr, Kimball AB; National Psoriasis Foundation. Review of treatment options for psoriasis in pregnant or lactating women: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2012Abstract
  9. Jain V, Gordon C. Managing pregnancy in inflammatory rheumatological diseases. Arthritis Res Ther. 2011Abstract
  10. van der Woude CJ, Kolacek S, Dotan I, Oresland T, Vermeire S, Munkholm P, Mahadevan U, Mackillop L, Dignass A; European Crohn's Colitis Organisation (ECCO). European evidenced-based consensus on reproduction in inflammatory bowel disease. J Crohns Colitis. 2010Abstract Full text (link to original source) Full text (in our servers)
  11. Correia LM, Bonilha DQ, Ramos JD, Ambrogini O, Miszputen SJ. Inflammatory bowel disease and pregnancy: report of two cases treated with infliximab and a review of the literature. Eur J Gastroenterol Hepatol. 2010Abstract
  12. Mottet C, Vader JP, Felley C, Froehlich F, Gonvers JJ, Juillerat P, Stockbrügger R, Angelucci E, Seibold F, Michetti P, Pittet V; EPACT II Study Group. Appropriate management of special situations in Crohn's disease (upper gastro-intestinal; extra-intestinal manifestations; drug safety during pregnancy and breastfeeding): Results of a multidisciplinary international expert panel-EPACT II. J Crohns Colitis. 2009Abstract Full text (in our servers)
  13. Jürgens TP, Schaefer C, May A. Treatment of cluster headache in pregnancy and lactation. Cephalalgia. 2009Abstract
  14. Henderson JJ, Hartmann PE, Newnham JP, Simmer K. Effect of preterm birth and antenatal corticosteroid treatment on lactogenesis II in women. Pediatrics. 2008Abstract Full text (link to original source) Full text (in our servers)
  15. Østensen M, Motta M. Therapy insight: the use of antirheumatic drugs during nursing. Nat Clin Pract Rheumatol. 2007Abstract
  16. Mottet C, Juillerat P, Pittet V, Gonvers JJ, Froehlich F, Vader JP, Michetti P, Felley C. Pregnancy and breastfeeding in patients with Crohn's disease. Digestion. 2007Abstract
  17. Heetun ZS, Byrnes C, Neary P, O'Morain C. Review article: Reproduction in the patient with inflammatory bowel disease. Aliment Pharmacol Ther. 2007Abstract Full text (link to original source) Full text (in our servers)
  18. Powrie RO, Larson L, Miller M. Managing asthma in expectant mothers. Treat Respir Med. 2006Abstract
  19. National Asthma Education and Prevention Program Asthma and Pregnancy Working Group. Quick Reference from the Working Group Report on Managing asthma during pregnancy: recommendations for pharmacologic treatment-2004 update. 2004;1-12. 2004 Full text (link to original source) Full text (in our servers)
  20. National Asthma Education and Prevention Program Asthma and Pregnancy Working Group. Managing asthma during pregnancy: recommendations for pharmacologic treatment-2004 update. 2004;1-57. 2004 Full text (link to original source) Full text (in our servers)
  21. Moretti ME, Sgro M, Johnson DW, Sauve RS, Woolgar MJ, Taddio A, Verjee Z, Giesbrecht E, Koren G, Ito S. Cyclosporine excretion into breast milk. Transplantation. 2003Abstract
  22. Avci S, Yilmaz C, Sayli U. Comparison of nonsurgical treatment measures for de Quervain's disease of pregnancy and lactation. J Hand Surg Am. 2002Abstract
  23. Munoz-Flores-Thiagarajan KD, Easterling T, Davis C, Bond EF. Breast-feeding by a cyclosporine-treated mother. Obstet Gynecol. 2001Abstract
  24. Friedman S. Management of inflammatory bowel disease during pregnancy and nursing. Semin Gastrointest Dis. 2001Abstract
  25. Janssen NM, Genta MS. The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy, and lactation. Arch Intern Med. 2000Abstract Full text (link to original source) Full text (in our servers)
  26. Nyberg G, Haljamäe U, Frisenette-Fich C, Wennergren M, Kjellmer I. Breast-feeding during treatment with cyclosporine. Transplantation. 1998Abstract
  27. Connell WR. Safety of drug therapy for inflammatory bowel disease in pregnant and nursing women. Inflamm Bowel Dis. 1996Abstract
  28. Bunker CB, Erskine K, Rustin MH, Gilkes JJ. Severe polymorphic eruption of pregnancy occurring in twin pregnancies. Clin Exp Dermatol. 1990Abstract
  29. Needs CJ, Brooks PM. Antirheumatic medication during lactation. Br J Rheumatol. 1985Abstract