Is it safe to use steroids, such as prednisolone, while breastfeeding?

Safety of Steroids During Breastfeeding

Prednisone ≤20 mg daily is safe to use while breastfeeding, but for doses >20 mg daily, mothers should wait at least 4 hours after taking the medication before breastfeeding to minimize infant exposure. 1

General Principles of Steroid Use During Breastfeeding

• Corticosteroids have been used extensively during breastfeeding with no evidence of harmful effects on infants 1
• The amount of medication that enters breast milk depends on maternal serum concentration and pharmacological properties of the medication 2
• For breastfeeding patients requiring systemic immunomodulators, prednisone ≤20 mg daily is recommended only for acute, widespread flares 1

Specific Recommendations for Prednisolone

Dosing Considerations:

• For doses ≤20 mg daily (or equivalent nonfluorinated glucocorticoid): No interruption in breastfeeding is necessary 1
• For doses >20 mg daily: Women should delay breastfeeding or discard breast milk accumulated in the 4 hours following glucocorticoid administration 1

Safety Data:

• The relative infant dose (RID) for methylprednisolone (IV form) has been measured at only 0.71% of the weight-adjusted maternal dose, which is well below the generally accepted safety threshold of 10% 3
• Cmax (maximum concentration) in breast milk occurs at 1-2 hours after infusion and decreases significantly by 4-8 hours 3

Clinical Application Algorithm

1. Assess necessity of steroid therapy:

   • Determine if steroids are required for acute flare or disease management 1
   • Consider if alternative medications might be equally effective but with better safety profile 1

2. Determine appropriate dosing:

   • If ≤20 mg daily of prednisone is sufficient: No special precautions needed 1
   • If >20 mg daily is required: Plan administration around breastfeeding schedule 1

3. Timing recommendations for high-dose steroids:

   • Take medication immediately after breastfeeding 1
   • Wait at least 4 hours before next breastfeeding session 1
   • Consider pumping and discarding milk during this 4-hour window if needed 1

4. Duration of therapy:

   • Use the lowest effective dose for the shortest duration possible 1
   • Monitor infant for any adverse effects during therapy 4

Special Considerations

• Short-term, high-dose pulse therapy (such as IV methylprednisolone) may be used with minimal risk to the breastfed infant, especially if breastfeeding is delayed for 2-4 hours after infusion 3
• The benefits of breastfeeding generally outweigh the minimal risks of steroid exposure through breast milk 5
• Maintaining maternal disease control with lactation-compatible medications is important for both mother and infant health 1

Common Pitfalls to Avoid

• Unnecessarily discontinuing breastfeeding due to concerns about steroid use 6
• Using higher doses of steroids than necessary 1
• Failing to consider the timing of medication administration in relation to breastfeeding schedule 1
• Not informing patients about the safety of continuing breastfeeding while on appropriate steroid therapy 2