Can I take prednisone (corticosteroid) while breastfeeding?

Prednisone Use During Breastfeeding

Prednisone at doses less than 20 mg daily is strongly recommended as compatible with breastfeeding, but for doses of 20 mg daily or higher, women should delay breastfeeding or discard breast milk accumulated in the 4 hours following glucocorticoid administration. 1, 2, 3

Dosage-Based Recommendations

• Prednisone doses less than 20 mg daily (or equivalent nonfluorinated glucocorticoid):

  • Safe for use during breastfeeding with no special precautions needed 1, 2, 3
  • No interruption in breastfeeding is necessary 3

• Prednisone doses 20 mg daily or higher:

  • Delay breastfeeding or discard breast milk accumulated in the 4 hours following glucocorticoid administration 1, 2, 3
  • This approach minimizes infant exposure while maintaining maternal treatment benefits 2

Clinical Application Algorithm

1. Determine necessity of prednisone therapy:

   • Consider if prednisone is required for acute flare or disease management 3
   • Evaluate if alternative medications might be equally effective with better safety profile 3

2. Dosing considerations:

   • If ≤20 mg daily is sufficient: Continue breastfeeding as normal 2, 3
   • If >20 mg daily is required: Plan administration around breastfeeding schedule 3

3. Timing administration with breastfeeding (for doses ≥20 mg):

   • Take medication immediately after breastfeeding 3
   • Wait at least 4 hours before next breastfeeding session 3
   • Consider pumping and discarding milk during this 4-hour window if needed 3

Important Considerations

• Maintaining maternal disease control with lactation-compatible medications is important for both mother and infant health 1, 2
• Short-term use of prednisone poses particularly low risk to the breastfed infant 2
• Systemically administered corticosteroids do appear in human milk but at doses <20 mg daily, the amount transferred is minimal 4

Common Pitfalls to Avoid

• Using higher doses of prednisone than necessary for disease control 3
• Failing to consider the timing of medication administration in relation to breastfeeding schedule 3
• Unnecessarily discontinuing breastfeeding when using low-dose prednisone (<20 mg daily) 1, 2
• Failing to collaborate with pediatricians when making recommendations about medication use during breastfeeding 1

Alternative Considerations

• For some conditions, NSAIDs may be considered as alternative anti-inflammatory medications and are generally compatible with breastfeeding for short-term use 2, 5
• When taking medications while breastfeeding, mothers should be instructed to take their medication after breastfeeding when possible, at the lowest effective dose, and for the shortest duration 5