From the Guidelines
Mometasone is generally considered acceptable during breastfeeding, as the amount that passes into breast milk is minimal, especially when used in nasal sprays or topical formulations. The most recent and highest quality study, published in the European Respiratory Journal in 2020 1, provides guidance on the management of reproduction and pregnancy in women with airways diseases, including the use of medications during breastfeeding. According to this study, the risk of mometasone passing into breast milk is low, and the benefits of treating the mother's condition often outweigh the minimal risks to the breastfed infant.
When considering the use of mometasone during breastfeeding, it's essential to note that the formulation and dosage are crucial factors. Nasal sprays, such as Nasonex, and topical formulations, like creams or ointments, have very low systemic absorption, meaning that very little of the medication enters the bloodstream and subsequently the breast milk. For inhaled mometasone, like Asmanex, the risk is also low, as the medication primarily acts locally in the lungs.
However, if oral or injectable forms of corticosteroids are used, which have higher systemic absorption, it's recommended to discuss this specifically with a healthcare provider, as they may recommend monitoring the baby for potential side effects, such as poor weight gain or irritability. The benefits of treating the mother's condition, whether it's asthma, allergies, or skin conditions, often outweigh the minimal risks to the breastfed infant, as untreated maternal conditions can impact the ability to care for the baby effectively.
In general, the use of any medication during breastfeeding requires careful consideration of the benefits and risks, and the lowest effective dose should be used for the shortest duration needed. As stated in the study published in the Journal of Allergy and Clinical Immunology in 2008 1, intranasal corticosteroids, including mometasone, may be used during pregnancy and breastfeeding due to their safety and efficacy profile, and the reported safety data on all intranasal corticosteroids have been reassuring.
From the FDA Drug Label
Nursing Mothers: Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects. It is not known whether topical administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in human milk Because many drugs are excreted in human milk, caution should be exercised when Mometasone Furoate Lotion (Mometasone Furoate Topical Solution USP 0.1%) is administered to a nursing woman.
Mometasone use in breastfeeding is not explicitly contraindicated, but caution is advised due to the potential for systemic absorption and effects on the infant 2.
From the Research
Mometasone and Breastfeeding
- There is limited information available on the use of mometasone during breastfeeding 3, 4, 5.
- A study on the pharmacological properties of mometasone found that it is a potent glucocorticoid with low potential to cause adverse systemic effects, such as suppression of the hypothalamic-pituitary-adrenal axis 6.
- Another study on the safety and systemic effects of mometasone furoate nasal spray found that it does not reach high systemic concentrations or cause clinically significant adverse effects, and is not associated with growth inhibition in children 7.
- However, none of the studies provide direct information on the safety of mometasone during breastfeeding.
- Healthcare professionals should consider reviewing data behind the recommendations and consulting multiple resources when making decisions regarding medication use during lactation 4.