Hydrocortisone

Drug Levels and Effects:




Summary of Use during Lactation:


Hydrocortisone (cortisol) is a normal component of breastmilk that passes from the mother's bloodstream into milk. Hydrocortisone has not been studied in breastmilk after exogenous administration in pharmacologic amounts. Although it is unlikely that dangerous amounts of hydrocortisone would reach the infant, a better studied alternate corticosteroid might be preferred. See also Hydrocortisone, Topical.


Drug Levels:


Maternal Levels.

An unspecified number of mothers had endogenous breastmilk cortisol (hydrocortisone) levels measured at various random times postpartum. Milk cortisol levels ranged from 7 to 33 mcg/L during the first 10 days postpartum; levels after 40 days postpartum were 6 to 17 mcg/L.[1]

Cortisol was measured in the colostrum and milk of 11 women monthly for up to 12 months postpartum. Levels in late pregnancy averaged 24.5 mcg/L and fell over the first 10 days postpartum to an average of 1.8 mcg/L. Milk cortisol levels between months 2 and 12 averaged 7.2 mcg/L, but varied with time and among individuals (range 0.2 to 32 mcg/L).[2]

Free cortisol was measured in 13 women on days 1, 2, and 3 postpartum (7 spontaneous births) or days 3, 4, and 5 postpartum (6 elective cesarean sections). Milk levels were measured before and after nursing, but the values were not statistically different. In the women with spontaneous deliveries, before and after milk levels averaged 17.2 mcg/L on day 1, 16.8 mcg/L on day 2, and 7.4 mcg/L on day 3 postpartum. In the women with cesarean deliveries, before and after milk levels averaged 26.5 mcg/L on day 3, 15.1 mcg/L on day 4, and 14.1 mcg/L on day 6 postpartum.[3]

Infant Levels.

Relevant published information was not found as of the revision date.


Effects in Breastfed Infants:


None reported with any systemic corticosteroid.


Possible Effects on Lactation:


Published information on the effects of hydrocortisone on serum prolactin or on lactation in nursing mothers was not found as of the revision date.

A study of 46 women who delivered an infant before 34 weeks of gestation found that a course of another corticosteroid (</span>betamethasone, 2 intramuscular injections of 11.4 mg ofbetamethasone24 hours apart) given between 3 and 9 days before delivery resulted in delayed lactogenesis II and lower average milk volumes during the 10 days after delivery. Milk volume was not affected if the infant was delivered less than 3 days or more than 10 days after the mother received the corticosteroid.[3] An equivalent dosage regimen of hydrocortisone might have the same effect.

A study of 87 pregnant women found thatbetamethasonegiven as above during pregnancy caused a premature stimulation of lactose secretion during pregnancy. Although the increase was statistically significant, the clinical importance appears to be minimal.[4] An equivalent dosage regimen of hydrocortisone might have the same effect.


Alternate Drugs to Consider:


(Systemic) Methylprednisolone,Prednisolone,Prednisone


References:


1. Rosner W, Beers PC, Awan T, Khan MS. Identification of corticosteroid-binding globulin in human milk: measurement with a filter disk assay. J Clin Endocrinol Metab. 1976;42:1064-73. PMID:932172
2. Kulski JK, Hartmann PE. Changes in the concentration of cortisol in milk during different stages of human lactation. Aust J Exp Biol Med Sci. 1981;59 (Pt 6):769-78. PMID:7340774
3. Patacchiolo FR, Cigliana G, Cilumbriello A et al. Maternal plasma and milk free cortisol during the first 3 days of breast-feeding following spontaneous delivery or elective cesarean section. Gynecol Obstet Investig. 1992;34:159-63. PMID:1427417
4. Henderson JJ, Hartmann PE, Newnham JP, Simmer K. Effect of preterm birth and antenatal corticosteroid treatment on lactogenesis ii in women. Pediatrics. 2008;121:e92-100. PMID:18166549
5. Henderson JJ, Newnham JP, Simmer K, Hartmann PE. Effects of antenatal corticosteroids on urinary markers of the initiation of lactation in pregnant women. Breastfeed Med. 2009;4:201-6. PMID:19772378



Substance Identification:




Substance Name:

Hydrocortisone

CAS Registry Number:

50-23-7

Drug Class:


  • Corticosteroids, Systemic


  • Administrative Information:




    LactMed Record Number:


    138


    Last Revision Date:


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