Prednisone Safety During Breastfeeding
Prednisone at doses less than 20 mg daily is strongly recommended as compatible with breastfeeding and can be continued without interruption. 1
Dose-Specific Recommendations
Low-Dose Prednisone (≤20 mg daily)
- Prednisone ≤20 mg daily (or equivalent nonfluorinated glucocorticoid) is compatible with breastfeeding without any special precautions. 1
- No need to delay breastfeeding or discard breast milk at this dose range. 1
- The American College of Rheumatology strongly recommends this approach based on the favorable risk-benefit profile. 1
- The relative infant dose at this level is considered safe (typically <10% of maternal dose). 1
High-Dose Prednisone (≥20 mg daily)
- For doses ≥20 mg daily, women should delay breastfeeding or discard breast milk accumulated in the 4 hours following glucocorticoid administration. 1
- This timing recommendation minimizes infant exposure to peak drug concentrations in breast milk. 1
- The 4-hour window allows for drug clearance from breast milk while maintaining maternal treatment benefits. 1
Clinical Implementation Algorithm
Step 1: Assess the required prednisone dose
- Determine the minimum effective dose needed for maternal disease control. 1
- Prioritize maintaining disease control with lactation-compatible medications. 1
Step 2: Apply dose-specific guidelines
- If ≤20 mg daily: Continue breastfeeding normally without interruption. 1
- If ≥20 mg daily: Plan medication administration around the infant's longest sleep interval. 1
Step 3: For high-dose regimens
- Administer prednisone immediately after a breastfeeding session. 1
- Wait 4 hours before the next breastfeeding session. 1
- Consider pumping and discarding milk during this 4-hour window if breast engorgement occurs. 1
Evidence Quality and Guideline Consensus
The most recent 2025 EULAR recommendations and 2020 American College of Rheumatology guidelines are in complete agreement on prednisone safety during breastfeeding. 1 Both guidelines provide strong recommendations for low-dose use and conditional recommendations with timing precautions for high-dose use. 1
The FDA drug label notes that systemically administered corticosteroids appear in human milk, but does not provide specific dose-based guidance, leaving clinical decision-making to the more detailed rheumatology guidelines. 2
Common Pitfalls to Avoid
Do not unnecessarily discontinue breastfeeding for low-dose prednisone (≤20 mg daily). 1 This is a common error that deprives infants of breastfeeding benefits without medical justification.
Do not use higher doses than necessary. 1 Always use the minimum effective dose to control maternal disease while minimizing infant exposure.
Do not fail to time medication administration strategically. 1 For doses ≥20 mg daily, administering the medication without considering the breastfeeding schedule increases unnecessary infant exposure.
Do not confuse prednisone with fluorinated glucocorticoids. 1 The recommendations specifically apply to nonfluorinated glucocorticoids like prednisone and prednisolone.
Multidisciplinary Collaboration
Collaboration between rheumatologists, primary care physicians, and pediatricians is recommended when managing breastfeeding women on corticosteroid therapy. 1 This ensures coordinated care that balances maternal disease control with infant safety.
Short-Term vs. Long-Term Use
For short-term use, the risk to the infant is particularly low when using prednisone at recommended doses. 3 Long-term use at any dose should still follow the same dose-based guidelines outlined above. 1