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

Prednisolone

October 27, 2014 (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 7.5 mg for a long time period. At a daily dose of 60 mg used for treatment of Herpes or Gestational Pemphigus no harm effects on breastfed infants have been reported.

On long term treatments it would be advisable to wait for 3 - 4 hours until the next nurse to minimize the transfer of drug to breast milk.

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 Prednisolone 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.

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). 2016 Abstract Full text (link to original source) Full text (in our servers)
  2. Damas OM, Deshpande AR, Avalos DJ, Abreu MT. Treating Inflammatory Bowel Disease in Pregnancy: The Issues We Face Today. J Crohns Colitis. 2015 Abstract Full text (in our servers)
  3. van der Woude CJ, Ardizzone S, Bengtson MB, Fiorino G, Fraser G, Katsanos K, Kolacek S, Juillerat P, Mulders AG, Pedersen N, Selinger C, Sebastian S, Sturm A, Zelinkova Z, Magro F; European Crohn’s and Colitis Organization. The second European evidenced-based consensus on reproduction and pregnancy in inflammatory bowel disease. J Crohns Colitis. 2015 Abstract Full text (link to original source) Full text (in our servers)
  4. Sammaritano LR, Bermas BL. Rheumatoid arthritis medications and lactation. Curr Opin Rheumatol. 2014 Abstract
  5. Schulze H, Esters P, Dignass A. Review article: the management of Crohn's disease and ulcerative colitis during pregnancy and lactation. Aliment Pharmacol Ther. 2014 Abstract Full text (link to original source) Full text (in our servers)
  6. Babwah TJ, Nunes P, Maharaj RG. An unexpected temporary suppression of lactation after a local corticosteroid injection for tenosynovitis. Eur J Gen Pract. 2013 Abstract
  7. Yarur A, Kane SV. Update on pregnancy and breastfeeding in the era of biologics. Dig Liver Dis. 2013 Abstract Full text (link to original source) Full text (in our servers)
  8. Westermann L, Hügel R, Meier M, Weichenthal M, Zillikens D, Gläser R, Schmidt E. Glucocorticosteroid-resistant pemphigoid gestationis: successful treatment with adjuvant immunoadsorption. J Dermatol. 2012 Abstract
  9. Gan DC, Welsh B, Webster M. Successful treatment of a severe persistent case of pemphigoid gestationis with antepartum and postpartum intravenous immunoglobulin followed by azathioprine. Australas J Dermatol. 2012 Abstract
  10. 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. 2012 Abstract
  11. Habal FM, Huang VW. Review article: a decision-making algorithm for the management of pregnancy in the inflammatory bowel disease patient. Aliment Pharmacol Ther. 2012 Abstract Full text (link to original source) Full text (in our servers)
  12. McGuire E. Sudden loss of milk supply following high-dose triamcinolone (Kenacort) injection. Breastfeed Rev. 2012 Abstract
  13. Jain V, Gordon C. Managing pregnancy in inflammatory rheumatological diseases. Arthritis Res Ther. 2011 Abstract
  14. 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. 2010 Abstract
  15. Van Assche G, Dignass A, Reinisch W, van der Woude CJ, Sturm A, De Vos M, Guslandi M, Oldenburg B, Dotan I, Marteau P, Ardizzone A, Baumgart DC, D'Haens G, Gionchetti P, Portela F, Vucelic B, Söderholm J, Escher J, Koletzko S, Kolho KL, Lukas M, Mottet C, et al. The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Special situations. J Crohns Colitis. 2010 Abstract Full text (in our servers)
  16. 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. 2010 Abstract Full text (link to original source) Full text (in our servers)
  17. Jürgens TP, Schaefer C, May A. Treatment of cluster headache in pregnancy and lactation. Cephalalgia. 2009 Abstract
  18. 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. 2009 Abstract Full text (in our servers)
  19. Henderson JJ, Hartmann PE, Newnham JP, Simmer K. Effect of preterm birth and antenatal corticosteroid treatment on lactogenesis II in women. Pediatrics. 2008 Abstract Full text (link to original source) Full text (in our servers)
  20. 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. 2007 Abstract
  21. Østensen M, Motta M. Therapy insight: the use of antirheumatic drugs during nursing. Nat Clin Pract Rheumatol. 2007 Abstract
  22. Heetun ZS, Byrnes C, Neary P, O'Morain C. Review article: Reproduction in the patient with inflammatory bowel disease. Aliment Pharmacol Ther. 2007 Abstract Full text (link to original source) Full text (in our servers)
  23. Powrie RO, Larson L, Miller M. Managing asthma in expectant mothers. Treat Respir Med. 2006 Abstract
  24. 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)
  25. 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)
  26. 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. 2003 Abstract
  27. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  28. Avci S, Yilmaz C, Sayli U. Comparison of nonsurgical treatment measures for de Quervain's disease of pregnancy and lactation. J Hand Surg Am. 2002 Abstract
  29. Munoz-Flores-Thiagarajan KD, Easterling T, Davis C, Bond EF. Breast-feeding by a cyclosporine-treated mother. Obstet Gynecol. 2001 Abstract
  30. Friedman S. Management of inflammatory bowel disease during pregnancy and nursing. Semin Gastrointest Dis. 2001 Abstract
  31. Pfeiffer C. [Dermatologic steroid therapy during pregnancy and lactation]. Hautarzt. 2001 Abstract
  32. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Abstract Full text (link to original source) Full text (in our servers)
  33. Janssen NM, Genta MS. The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy, and lactation. Arch Intern Med. 2000 Abstract Full text (link to original source) Full text (in our servers)
  34. Nyberg G, Haljamäe U, Frisenette-Fich C, Wennergren M, Kjellmer I. Breast-feeding during treatment with cyclosporine. Transplantation. 1998 Abstract
  35. Lockshin MD, Sammaritano LR. Corticosteroids during pregnancy. Scand J Rheumatol Suppl. 1998 Abstract
  36. Connell WR. Safety of drug therapy for inflammatory bowel disease in pregnant and nursing women. Inflamm Bowel Dis. 1996 Abstract
  37. Zielonka TM, Dabrowski A, Droszcz W. [Efficacy of slow-release betamethasone in Churg-Strauss syndrome. Apropos of a case]. Rev Pneumol Clin. 1994 Abstract
  38. Greenberger PA, Odeh YK, Frederiksen MC, Atkinson AJ Jr. Pharmacokinetics of prednisolone transfer to breast milk. Clin Pharmacol Ther. 1993 Abstract
  39. Ito S, Blajchman A, Stephenson M, Eliopoulos C, Koren G. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993 Abstract
  40. Petrus M, Netter JC, Rance F, Chateauneuf R, Bildstein G, Cabalet C, Sermet J, Delprat A. [Iatrogenic Cushing syndrome in infants. Report of a case with dwarfism]. Ann Pediatr (Paris). 1990 Abstract
  41. Bunker CB, Erskine K, Rustin MH, Gilkes JJ. Severe polymorphic eruption of pregnancy occurring in twin pregnancies. Clin Exp Dermatol. 1990 Abstract
  42. Anderson PO. Corticosteroid use by breast-feeding mothers. Clin Pharm. 1987 Abstract
  43. Needs CJ, Brooks PM. Antirheumatic medication during lactation. Br J Rheumatol. 1985 Abstract
  44. Ost L, Wettrell G, Björkhem I, Rane A. Prednisolone excretion in human milk. J Pediatr. 1985 Abstract
  45. Grekas DM, Vasiliou SS, Lazarides AN. Immunosuppressive therapy and breast-feeding after renal transplantation. Nephron. 1984 Abstract
  46. De Stefano P, Bongo IG, Borgna-Pignatti C, Severi F. Factitious hypertension with mineralocorticoid excess in an infant. Helv Paediatr Acta. 1983 Abstract
  47. Coulam CB, Moyer TP, Jiang NS, Zincke H. Breast-feeding after renal transplantation. Transplant Proc. 1982 Abstract
  48. McKenzie SA, Selley JA, Agnew JE. Secretion of prednisolone into breast milk. Arch Dis Child. 1975 Abstract Full text (in our servers)
  49. Katz FH, Duncan BR. Letter: Entry of prednisone into human milk. N Engl J Med. 1975 Abstract