Methylprednisolone

Drug Levels and Effects:




Summary of Use during Lactation:


Limited information indicates that maternal doses of methylprednisolone up to 8 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants. With high maternal doses, especially intravenous doses, avoiding breastfeeding for 3 to 4 hours after a dose should decrease the dose received by the infant. However, this maneuver is probably not necessary. Local injections, such as for tendinitis, would not be expected to cause any adverse effects in breastfed infants.


Drug Levels:


Maternal Levels.

In one woman taking 6 mg daily of methylprednisolone by mouth, 2 peak milk levels occurred: one at 2 hours after the dose and another 8 hours after the dose. Peaks were about 7 mcg/L, while levels fell to about 2.5 mcg/L 6 hours after the dose and to about 1 mcg/L 10 hours after the dose.[1]

Infant Levels.

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


Effects in Breastfed Infants:


None reported with methylprednisolone or any other corticosteroid. Three infants were breastfed from birth during maternal use of methylprednisolone 6 to 8 mg daily with no reported adverse effects up to 3 months.[1][2] In one of the papers, 2 infants had normal blood cell counts, no increase in infections and above average growth rates.[2]


Possible Effects on Lactation:


Published information on the effects of methylprednisolone on serum prolactin or on lactation in nursing mothers was not found as of the revision date. Adequate endogenous adrenocorticoid levels are necessary for normal lactation.[3]

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.[4] An equivalent dosage regimen of methylprednisolone might have the same effect.


Alternate Drugs to Consider:


Prednisolone,Prednisone


References:


1. Coulam CB, Moyer TP, Jiang NS et al. Breast-feeding after renal transplantation. Transplant Proc. 1982;13:605-9. PMID:6817481
2. Grekas DM, Vasiliou SS, Lazarides AN. Immunosuppresive therapy and breast-feeding after renal transplantation. Nephron. 1984;37:68. Letter. PMID:6371564
3. 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
4. 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:

Methylprednisolone

CAS Registry Number:

83-43-2

Drug Class:


  • Corticosteroids, Systemic


  • Administrative Information:




    LactMed Record Number:


    180


    Last Revision Date:


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