Is Prednisone (corticosteroid) safe during breastfeeding?

From the Guidelines

Prednisone is generally considered compatible with breastfeeding, with doses below 20 mg daily resulting in minimal amounts reaching breast milk, and for doses above 20 mg daily, it is recommended to discard breast milk obtained within 4 hours following medication 1.

Key Considerations

• For mothers who need prednisone for medical conditions, continuing to breastfeed while taking this medication is usually safe, with the benefits of treating the mother's condition typically outweighing the minimal risks to the infant 1.
• When possible, taking prednisone right after nursing and waiting 3-4 hours before the next feeding can minimize infant exposure, as the concentration of prednisolone in mother's milk and serum reaches equilibrium within this timeframe 1.
• For short-term, high-dose therapy, this timing approach is particularly helpful, while for long-term maintenance therapy, doses below 20 mg daily result in minimal amounts reaching breast milk, with the infant receiving less than 0.1% of the mother's dose 1.
• Very high doses (above 50-80 mg daily for extended periods) may potentially affect infant growth or adrenal function, though this is rare, and if required, healthcare providers might recommend monitoring the infant for symptoms like poor weight gain, excessive sleepiness, or irritability 1.

Recommendations

• Prednisone ≤20 mg daily is considered compatible with breastfeeding, with minimal amounts reaching breast milk 1.
• For doses of prednisone ≥20 mg daily, discard breast milk obtained within 4 hours following medication to minimize infant exposure 1.
• Monitor the infant for symptoms like poor weight gain, excessive sleepiness, or irritability if high-dose, long-term therapy is required 1.

From the FDA Drug Label

Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects Because of the potential for serious adverse reactions in nursing infants from corticosteroids, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother

Prednisone use while breastfeeding is associated with potential risks to the infant, including suppression of growth and interference with endogenous corticosteroid production.

• A decision should be made to either discontinue breastfeeding or discontinue the drug, considering the importance of the drug to the mother 2 2. Key considerations:
• Potential for serious adverse reactions in nursing infants
• Importance of the drug to the mother
• Need to weigh benefits and risks of continued breastfeeding or prednisone use.

From the Research

Prednisone and Breastfeeding

• Prednisone can be taken by nursing mothers, although when used at doses higher than 20 mg/day, an interval of 4 h after dosing and prior to breastfeeding is recommended 3.
• The amount of medication that enters breast milk varies based on the maternal serum concentration and the pharmacologic properties of the medication, and prednisone has been found to have minimal transfer into breast milk 4, 5.
• Breast-milk/plasma area under the concentration-time curve ratios were 0.5-0.6 for prednisone, and relative infant doses were 0.35% to 0.53% 5.

Safety Precautions

• When prescribing medications for a breastfeeding patient, those with the lowest risk to the infant should be selected, and dosing should be before the infant's longest sleep interval 4.
• Prescribers should use current, accurate resources, such as LactMed, to determine the safety of medications during breastfeeding 4.

Pharmacokinetics of Prednisone

• Prednisone exhibits dose- and concentration-dependent pharmacokinetics during pregnancy, and infant exposure to this agent via breast milk is minimal 5.
• The apparent oral clearance of prednisone increases with dose, and higher prednisone concentrations lead to a higher percentage of unbound drug 5.

Potential Adverse Effects

• Extended corticosteroid use, including prednisone, has been associated with increased incidence and earlier onset of adverse events, such as hypertension, pneumonia, and osteoporosis 6.
• Corticosteroids, including prednisone, have potential adverse effects, including toxicity to articular cartilage and numerous systemic side effects, such as increases in blood glucose levels and a reduction in immune function 7.