How long should you wait to breastfeed after taking corticosteroids (e.g. prednisone)?

Breastfeeding After Taking Corticosteroids

For prednisone/prednisolone doses ≤20 mg daily, no waiting period is necessary before breastfeeding. For doses >20 mg daily, wait at least 4 hours after taking the medication before breastfeeding to minimize infant exposure. 1, 2

Corticosteroid Safety During Breastfeeding

Low-Dose Corticosteroids (≤20 mg daily)

• Prednisone/prednisolone at doses ≤20 mg daily are considered fully compatible with breastfeeding 1
• At these doses, the amount transferred into breast milk is minimal (5-25% of serum concentration) 3
• The infant would ingest less than 0.1% of the maternal dose, which corresponds to less than 10% of the infant's endogenous cortisol production 3

Higher-Dose Corticosteroids (>20 mg daily)

• For doses >20 mg daily, breastfeeding is still considered safe but with precautions 1, 2
• Guidelines recommend waiting at least 4 hours after taking the medication before breastfeeding 2, 1
• This timing strategy minimizes infant exposure as corticosteroid levels in breast milk peak around the same time as serum levels 3

Specific Recommendations for Different Scenarios

For Acute Treatment (e.g., MS relapse, severe inflammatory flare)

• For IV pulse methylprednisolone treatment:
  • Highest concentrations in breast milk occur at the end of infusion 4
  • Waiting 2-4 hours after infusion before breastfeeding significantly reduces infant exposure 4
  • The relative infant dose is calculated to be approximately 0.50%, well below the 10% safety threshold 4

For Chronic Treatment

• For patients requiring long-term corticosteroid therapy:
  • Nonfluorinated steroids (prednisone/prednisolone) are preferred over fluorinated ones (dexamethasone, betamethasone) 1
  • Morning dosing may help synchronize peak drug levels with the longest interval before the next feeding 5

Special Considerations

Premature Infants

• More caution may be warranted as premature infants may have reduced capacity to metabolize medications 1
• Consultation with a pediatrician is recommended for individualized guidance

Practical Tips

• For doses >20 mg daily, consider pumping and storing milk before taking medication for use during the 4-hour waiting period
• Maintain disease control as a priority, as untreated maternal disease may have greater negative impacts than minimal medication exposure through breast milk 5

Common Pitfalls to Avoid

1. Unnecessarily discontinuing breastfeeding: Many healthcare providers may advise against breastfeeding due to theoretical concerns, despite evidence supporting safety
2. Ignoring timing strategies: Failing to consider the timing of medication in relation to breastfeeding can lead to higher infant exposure
3. Stopping necessary treatment: Discontinuing needed corticosteroid therapy can lead to disease flares, which may have more significant negative impacts on both mother and infant

Remember that the benefits of breastfeeding generally outweigh the minimal risk of corticosteroid exposure through breast milk, especially when appropriate timing strategies are employed.