Hydrocortisone and breast feeding

[Haley]

Hi, I am28 weeks pregnant and was diagnosed with adrenal insufficiency about 4 months before I found out I was pregnant. My ob has never had a patient with adrenal insufficiency and my endo is not sure if breast feeding is an option, he has said that cortisone does transfer into the milk , but that there is not enough data to show the side effects.I don't want my baby to have any heat
Lth problems because of my cortisone, I don't want her adrenal glands to stop producing because she is getting the cortisol through the breast milk. I have searched for hours on the Internet, unfortunately the information I have found goes both ways and just leaves me still confused and scared. I take 20 mg a day pre pregnancy I will take 100 mgs of a stress dose during delivery, if I am able to breast feed would it be unsafe to breast feed after delivery on a high stress dose? So my first question is can I safely breast feed on cortisone
Second if I can can I after delivery on a 100 mg stress dose ? Thank you soo much for your help



I was sent to you via the la leeche club

[admin]

Haley:

The cortisol injections you are receiving are basically to replace your insufficient supply. Thus they are unlikely to produce large or sustained plasma levels for very long. Cortisol, as a corticosteroid, is the weakest of the bunch, and it is very unlikely to pass into breastmilk. Most corticosteroids are virtually excluded from the milk compartment. The 100 mg stress dose will transfer slightly into your colostrum, but there is very little risk to your infant due to the low volume of colostrum produced daily.

I would not be concerned about this dose in you as far as breastfeeding.

Tom Hale, Ph.D.
Professor

[gslhdl]

I received a cortisone shot yesterday due to a cyst that ruptured on my hip. I have a 11 month old baby that I am still breastfeeding and wondered if I needed to pump and dump and if so, for how long before I can return to breastfeeding. Dermatologist said it was okay to breastfeed but pediatrician was unable to say for certain if safe.

[cpride]

Dear gslhdl,

Cortisone is a typical corticosteroid that is available for IV, oral, intra-articular (into a joint) and transcutaneous use. Although no data are available on cortisone secretion into human milk, it is likely that the milk levels would be exceedingly low and not clinically relevant when administered via inhalation or intranasally. There is virtually no risk to the infant following use of the intranasal or aerosol products in breastfeeding mothers. With topical application, limit the dose and frequency of use. For intra-articular injections, mothers should pump and discard for a minimum of 12 hours after injection. This allows the initial high concentration of the medication into the blood plasma to be eliminated (time that the medication would be highest in the breastmilk). Thereafter, the medication is secreted in minimal amounts over a few weeks which would be unlikely to affect a breastfed infant. If you have further questions, please call the InfantRisk Center at 806-352-2519. We are open Monday through Friday, 8 to 5, CST.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

[Gtlim]

I am currently on 60-80 mg hydrocortisone spread out over three doses in a day, for treatment of a flare of my autoimmune condition henoch schonlein purpura that is causing nephrotic syndrome. Once the relapse in under control, I will taper the dose back to maintenance dose, which I understand is safe to breastfeed. It may take a month to get back in remission and I wonder if I can breastfeed during this time. As the half life of hydrocortisone is 1.5 hours, could I breastfeed just before each of my six hourly doses? If at all. Thank you so much.

[admin]

Gtlim:

Corticosteroids in general are not a major problem in a breastfeeding women unless the oral or IV dose is really high, AND it is used over a long period of time, weeks to months. In general, they don't enter milk very well.

I'm not sure how you are using hydrocortisone ? Topically or orally, but it is one of the safer steroids to use since it is rather weak. I'd suggest these doses of this relatively weak steroid are probably ok to allow breastfeeding, particularly since you are reducing the dose.

If however, you extend the duration of treatment past a month, then you might want to have your pediatrician monitor the height of your infant and observe for changes.

Tom Hale PhD.

[cpride]

Dear Gtlim,

Steroids, in general, do not enter breastmilk well. For hydrocortisone, doses less than 200 mg are considered low. The first two hours after taking your dose is when the dose is expected to be at the maximum plasma concentration, therefore, at the highest level in your breastmilk as well. Half of the drug should be metabolized out in 8 to 12 hours. Dr. Hale recommends waiting four hours from the dose before returning to breastfeeding to reduce risk, so breastfeeding prior to taking your dose each time would be appropriate. Since you are taking hydrocortisone for longer than one month, your pediatrician should be monitoring your infant for growth.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

[Muellermr]

OTC 1% hydrocortisone cream

I seem to have some sort of reaction on a small area of my leg. Is it safe to use OTC 1% hydrocortisone cream while bf?

[admin-james]

Hi, thanks for your post.

Yes, it should be safe to use OTC hydrocotrisone on a small area while breastfeeding. Very little topical hydrocortisone passes into the bloodstream and even less into the milk. Be careful to wash your hands before breastfeeding so that you don't get any residual cream on the baby.

Please call us at the InfantRisk Center if this has not completely answered your question.*(806)352-2519

-James Abbey, MD