The amounts of inhaled budesonide excreted into breastmilk are minute and infant exposure is negligible. Reviewers and an expert panel consider inhaled corticosteroids acceptable to use during breastfeeding. When taken by mouth, budesonide is only about 9% bioavailable; bioavailability in the infant is likely to be similarly low for any budesonide that enters the breastmilk.
Eight women with asthma were using inhaled budesonide 200 mcg (n = 4) or 400 mcg twice daily (n = 4) by Pulmicort Turbihaler. Peak milk levels of budesonide of 168 ng/L and 335 ng/L occurred at 32 and 43 minutes after inhalation with the 200 mcg and 400 mcg doses, respectively. Average infant doses were estimated to be 6.8 and 14.2 ng/kg daily for the 200 mcg and 400 mcg dosages. A fully breastfed infant would receive a maximum of 0.3% of the weight-adjusted maternal dosage, assuming 100% oral bioavailability from breastmilk.
Four infants whose mothers were taking budesonide 200 mcg (n = 2) or 400 mcg (n = 2) twice daily by Pulmicort Turbihaler. The infants had serum samples taken 1.5 hours (range 0.7 to 2 hours) after the first breastfeeding after drug administration and 2.3 hours (range 2.1 to 2.6 hours) after maternal drug inhalation. All had undetectable (<8.6 to 17.2 ng/L) serum budesonide concentrations.
Effects in Breastfed Infants:
None reported with any corticosteroid.
Possible Effects on Lactation:
Relevant published information was not found as of the revision date.
1. Greenberger PA, Patterson R. The management of asthma during pregnancy and lactation. Clin Rev Allergy. 1987;5:317-24. PMID:3319123 2. Ellsworth A. Pharmacotherapy of asthma while breastfeeding. J Hum Lact. 1994;10:39-41. PMID:7619245 3. National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program Asthma and Pregnancy Working Group. NAEPP expert panel report. Managing asthma during pregnancy: recommendations for pharmacologic treatment-2004 update. 2004;1-57. http://www.nhlbi.nih.gov/health/prof/lung/asthma/astpreg.htm 4. Falt A, Bengtsson T, Kennedy BM et al. Exposure of infants to budesonide through breast milk of asthmatic mothers. J Allergy Clin Immunol. 2007;120:798-802. PMID:17825891
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