Triamcinolone Sistemic Use

A corticosteroid with a mainly glucocorticoid action and anti-inflammatory effects of similar strength to that of prednisolone.
Systemic administration (oral, injection), inhaled (bronchial, nasal), intra-articular, intravitreous and topical.
Indicated in the treatment of rheumatic diseases and collagen, inflammatory bowel disease, dermatitis, asthma, rhinitis, etc.

This comment is about systemic, intra-articular and ophthalmic triamcinolone.

Since the last update we have not found published data about its excretion in breast milk.

Administration of intra-articular triamcinolone in the wrist (Smuin 2016) or via an epidural in the cervical area (McGuire 2012) caused a temporary decrease in the production of milk lasting between one and four weeks that was resolved in both cases via the continuation and stimulation of breastfeeding.

The same has occurred, with a shorter duration, following the intra-articular administration of methylprednisolone (Babwah 2013).

Although after the administration of triamcinolone, both intraocular (Shen 2010, Degenring 2004), and epidural (Hooten 2016), elimination half-life is about 22-25 days, plasma levels are indetectable or very low, not clinically significant. The maximum concentration peak after these types of administration occurs at 24 hours (Hooten 2016, Shen 2010, Degenring 2004).

There is consensus among experts that, in general, neither systemic corticoids nor inhaled ones present a breastfeeding contraindication (National Asthma Education 2004).

The low plasma levels obtained after ophthalmic administration suggest a very low risk during breastfeeding.

Corticoids are of commonally used in pediatrics and have no side effects when they are used in isolation or in short-term treatments.

Until there is more published data about this drug in relation to breastfeeding, alternatives with a safer known pharmacokinetic profile for breastfeeding may be preferable (greater protein binding, lesser half-life and less oral bioavailability), especially during the neonatal period and in case of prematurity.

If used during breastfeeding it is advisable to monitor milk production.

• Methylprednisolone (Very Low Risk)
• Prednisolone (Very Low Risk)
• Triamcinolone (topical use) (Very Low Risk)
• Triamcinolone Inhaled (Very Low Risk)

Alternatives

• Prednisolone (Very Low Risk)
• Prednisone (Very Low Risk)