Is it safe to take cephalexin, Medrol (methylprednisolone) pack, and albuterol (inhaled) while breastfeeding?

Safety of Cephalexin, Medrol Pack, and Albuterol Inhaler During Breastfeeding

All three medications—cephalexin, methylprednisolone (Medrol pack), and inhaled albuterol—are safe to use while breastfeeding and do not require interruption of nursing.

Cephalexin Safety

Cephalexin is compatible with breastfeeding and poses minimal risk to the nursing infant. 1

• Cephalexin excretion into breast milk peaks at 4 hours after a 500 mg dose, reaching a maximum level of only 4 mcg/mL, then decreases gradually and disappears by 8 hours 1
• The FDA label states "caution should be exercised when cephalexin is administered to a nursing woman," but this is standard precautionary language rather than a contraindication 1
• The amount transferred to breast milk is clinically insignificant and well below levels that would affect the infant 1
• You can continue breastfeeding without any timing restrictions or need to pump and discard milk 2

Methylprednisolone (Medrol Pack) Safety

Methylprednisolone at typical Medrol pack doses is compatible with breastfeeding, though timing of feeds may optimize safety.

• The American College of Rheumatology recommends prednisone <20 mg daily (or equivalent non-fluorinated glucocorticoid like methylprednisolone) as compatible with breastfeeding 3
• A standard Medrol dose pack typically starts at 24 mg on day 1 and tapers down, which falls near the 20 mg threshold 3
• For doses ≥20 mg daily, delay breastfeeding or discard breast milk accumulated in the 4 hours following glucocorticoid administration 3
• For the lower doses in the taper (days 3-6), no special precautions are needed beyond standard breastfeeding 3

Practical Approach for Medrol Pack:

• Days 1-2 (higher doses): Feed immediately before taking the medication, then wait 4 hours or discard milk from that 4-hour window 3
• Days 3-6 (lower doses): Breastfeed normally without restrictions 3

Inhaled Albuterol Safety

Inhaled albuterol is safe during breastfeeding with negligible infant exposure.

• The FDA label notes uncertainty about albuterol excretion in human milk but does not contraindicate breastfeeding 4
• Inhaled medications result in minimal systemic absorption compared to oral forms, making them particularly safe for breastfeeding 5
• The inhaled route delivers medication directly to the lungs with very low plasma concentrations, resulting in negligible transfer to breast milk 5
• No timing restrictions or interruption of breastfeeding is necessary 5

Important Monitoring Considerations

Monitor your infant for any unusual symptoms, though adverse effects are highly unlikely with these medications.

• Watch for uncharacteristic fussiness, feeding changes, or rash, though these are rare with the medications in question 2
• Infants under 6 weeks of age have immature hepatic and renal function, but these three medications remain safe even in this age group 6
• The benefits of continued breastfeeding substantially outweigh the minimal theoretical risks from these medications 7, 8

Key Pitfalls to Avoid

• Do not unnecessarily discontinue breastfeeding based on generic warnings in package inserts—most medications are compatible with nursing 5, 8
• Do not pump and discard milk for cephalexin or inhaled albuterol, as this is completely unnecessary 1, 5
• Do not avoid necessary treatment out of fear of harming the infant—untreated maternal illness poses greater risk than medication exposure through breast milk 8, 9