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hydroxychloroquine and prednisone

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  • #1

    hydroxychloroquine and prednisone

    I am nursing my 4 month old baby. Recently diagnosed with aggressive RA and already have bone damage. Have been trying to not take drugs and been using supplements and diet for 3 months. My doctor is recommending prednisone and hydroxychloroquine are safe to start now and not quit. Thoughts on that? Also he is saying I need to soon start biologics and will need to quit nursing at that time. I'm wondering if that is true in your opinion.
    Thanks!
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  • #2
    Dear sdevore1,

    Dr. Hale states that small amounts of prenisone-prednisolone are transferred to the breast milk, although it is probably safe in breastfeeding. There is concern of growth impairment in breastfed infants with high-dose prolonged steroid therapy. Recommend using low-dose therapy or high dose short term therapy. In small doses, most steroids are certainly not contraindicated in nursing mothers. Following administration, wait at least 4 hours if possible prior to feeding infant to reduce exposure. With high doses (>40 mg/day), particularly for long periods, steroids could potentially produce problems in infant growth and development, although we have absolutely no data in this area, or which doses would pose problems. Brief applications of high dose steroids are probably not contraindicated as the overall exposure is low. With prolonged high dose therapy, the infant should be closely monitored for growth and development.
    Hydroxychloroquine (HCQ) is effective in the treatment of malaria but is also used in immune syndromes such as rheumatoid arthritis and systemic lupus erythematosus (SLE). Due to its huge volume of distribution, milk levels are generally quite low, and therefore this drug maybe considered compatible with breastfeeding. The time the medication is highest in your breastmilk is the first two hours after your dose so try to avoid breastfeeding during that time.
    If you have further questions, please call us at the InfantRisk Center, 806-352-2519. We are open Monday through Friday, 8 to 5, CDT.

    Sincerely,
    Cindy Pride, MSN, CPNP
    TTUHSC InfantRisk Center

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