oral or parenteral corticosteroids (steroids) during breastfeeding

Last edited 07/2023 and last reviewed 11/2023

Using oral or parenteral corticosteroids (steroids) during breastfeeding

Seek expert advice.

Recommended oral or parenteral (injected) corticosteroids of choice during breastfeeding include beclometasone, budesonide, hydrocortisone, methylprednisolone and prednisolone (1)

  • is regardless of whether they are given orally or parenterally (although not all medicines are available as both forms)
  • try to minimise infant exposure by using the lowest effective dose for the shortest effective duration
  • is very limited information on the use of corticosteroids during breastfeeding, although they are likely to be present in milk
  • short-term use of high dose steroids is normally considered compatible with breastfeeding as the overall exposure will still be low
  • medium to large doses of depot corticosteroids injected into joints have been reported to cause temporary reduction of lactation (2)

Avoid prolonged high dose therapy where possible since adrenal suppression and other side-effects may occur in the infant. Where such use is unavoidable, monitor the infant's adrenal function.

Consideration also needs to be given to monitoring the infant at lower doses if the clinical situation is more complex, for example, if the infant is premature or unwell, or there is exposure to additional medicines via breast milk with similar side-effects.

Prednisolone and breastfeeding

  • amounts of prednisolone in breastmilk are very low (2)
  • although it is often recommended to avoid breastfeeding for 4 hours after a dose this maneuver is not necessary because prednisolone milk levels are very low (2)
  • high doses might occasionally cause temporary loss of milk supply (2)

Corticosteroids are used for a wide range of indications. Therefore, choice should primarily be directed at adequately treating the condition first, with safety in breastfeeding a secondary consideration.

Notes:

  • where possible, choose topical or inhaled routes of administration (3)
    • will give lower systemic concentrations, which should lead to lower concentrations in breast milk
    • is no published evidence to support the use of topical or inhaled, corticosteroids during breastfeeding
      • however, many have been used historically during breastfeeding for years without any reported issues
      • are often used on a short-term basis which further supports their compatibility during breastfeeding
      • is no preferred corticosteroid and all are considered compatible
    • practical tips if using topical corticosteroid and breastfeeding
      • precautions should be taken to avoid direct contact of the breastfeeding infant with treated areas, such as washing hands thoroughly after application and before touching the infant
        • if a topical corticosteroid needs to be applied to the breast itself (especially nipples and areola) a mild or moderate potency preparation is preferred
        • should be removed with warm water before breastfeeding, and be reapplied after feeding
        • creams are preferred to ointments due to ease of removal

Reference:

Related pages:

breastfeeding

steroids in pregnancy