Prednisolone and Breastfeeding

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The information provided is taken from various reference sources.  It is provided as a guideline.  No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used.  Clinical decisions remain the responsibility of medical and breastfeeding practitioners.  The data presented here is intended to provide some immediate information but cannot replace input from professionals.

Prednisolone can be taken by a breastfeeding mother in doses up to 40mg a day to treat asthma, rheumatoid arthritis, inflammatory bowel disease or for an allergic reaction.

Prednisolone is a corticosteroid used to treat a variety of conditions including asthma, inflammatory bowel disease, allergic reaction and rheumatoid disease.

The action of this drug is to dampen the body’s response to inflammation. It can be life-saving. Sometimes it is used as a short course of 40mg (eight tablets of 5mg taken once daily) but may also be used long term at gradually reducing doses in chronic conditions.

Prednisolone is extensively bound to plasma proteins and passes into breastmilk in small quantities. Maternal doses of prednisolone up to 40 mg produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants (Greenberger et al. 1993; McKenzie et al. 1975; Ost et al. 1985). High-dose steroids (more than 40 mg) are rarely necessary long term and so can be used in breastfeeding.

The BNF recommends waiting 4 hours after administration if possible to minimise exposure – this may not be practical advice for most breastfeeding mothers and is not necessary at this dose.

The maximum level in breastmilk occurs one hour after dosage. Even at a maternal dose of 80 mg the maximum level of drug in breastmilk was recorded by Ost was 317 microgramme per litre.

Prednisolone is licensed at a dose of 2 mg per kilogramme to a maximum of 60 mg in children over the age of 2 years. With prolonged high doses over 40 mg monitoring of the infant for growth may be advisable but no reports of problems have been reported in the literature and this may be only a theoretical problem (Committee on Safety of Medicines, Medicines ControlnAgency 1998). This recommendation refers to direct levels administered to the child and not to the level being taken by a breastfeeding mother.

The benefit of treatment with corticosteroids during pregnancy and breastfeeding outweighs the risk to the baby. The BNF states that prednisolone appears in small amounts in breastmilk but maternal doses of up to 40 mg daily are unlikely to cause systemic effects in the infant; infants should be monitored for adrenal suppression if the mothers are taking a higher dose.

References

  • Committee on Safety of Medicines, Medicines Control Agency. Systemic corticosteroids in pregnancy and lactation, Current Problems 1998;24
  • Greenberger PA, Odeh YK, Frederiksen MC, Atkinson AJ Jr, Pharmacokinetics of prednisolone transfer to breastmilk, Clin Pharmacol Ther, 1993;53:324–8.
  • McKenzie SA, Selley JA, Agnew JE, Secretion of prednisolone into breastmilk, Arch Dis Child, 1975;50:894–6.
  • Ost L, Wettrell G, Bjorkhem I, Rane A, Prednisolone excretion in human milk, J Pediatr, 1985;106:1008–11

Bibliography

  • Jones W Breastfeeding and Medication Routledge
  • Hale T Medications and Mothers Milk
  • LACTMED online access

©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network Sept 2019