Prednisone

Drug Levels and Effects:




Summary of Use during Lactation:


Limited information indicates that maternal doses of prednisone up to 20 mg produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants. With high maternal doses, the use of prednisolone instead of prednisone and avoiding breastfeeding for 3 to 4 hours after a dose should decrease the dose received by the infant. However, these maneuvers are probably not necessary in most cases.


Drug Levels:


Maternal Levels.

After oral prednisone, peak milk levels of total prednisone plus prednisolone were 28.3 mcg/L after a 10 mg oral dose in one woman;[1] 102 mcg/L after a 20 mg dose in a second;[2] and 627 mcg/L after a 120 mg dose in another.[3] Peak milk steroid levels occur about 2 hours after a dose of prednisone.[1][2][3]

Infant Levels.

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


Effects in Breastfed Infants:


None reported with prednisone or any other corticosteroid. In a prospective follow-up study, six nursing mothers reported taking prednisone (dosage unspecified) with no adverse infant effects.[4] There are several reports of mothers breastfeeding during long-term use of corticosteroids with no adverse infant effects: prednisone 10 mg daily (2 infants)[5][6] and prednisolone 5 to 7.5 mg daily (14 infants).[7]

A woman with Crohn's disease used prednisone 60 mg/day in a tapering schedule immediately postpartum during breastfeeding (extent not stated). She also received sulfasalazine 4 g/day and infliximab 5 mg/kg every 8 weeks during pregnancy and postpartum. At 6 months of age, the infant was asymptomatic with regular weight gain.[8]


Possible Effects on Lactation:


Published information on the effects of prednisone 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.[9]

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.[10] An equivalent dosage regimen of prednisone might have the same effect.


Alternate Drugs to Consider:


Methylprednisolone,Prednisolone


References:


1. Katz FH, Duncan BR. Entry of prednisone into human milk. N Engl J Med. 1975;293:1154. Letter. PMID:1186783
2. Sagraves R, Kaiser D, Sharpe GL. Prednisone and prednisolone concentrations in the milk of a lactating mother. Drug Intell Clin Pharm. 1981;15:484. Abstract.
3. Berlin Jr CM, Kaiser DG, Demers L. Excretion of prednisone and prednisolone in human milk. Pharmacologist. 1979;21:264. Abstract.
4. Ito S, Blajchman A, Stephenson M et al. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993;168:1393-9. PMID:8498418
5. Moretti ME, Sgro M, Johnson DW et al. Cyclosporine excretion into breast milk. Transplantation. 2003;75:2144-6. PMID:12829927
6. Munoz-Flores-Thiagarajan KD, Easterling T, Davis C et al. Breast-feeding by a cyclosporine-treated mother. Obstet Gynecol. 2001;97(5 pt 2):816-8. PMID:11336764
7. Nyberg G, Haljamae U, Frisenette-Fich C et al. Breast-feeding during treatment with cyclosporine. Transplantation. 1998;65:253-5. PMID:9458024
8. Correia LM, Bonilha DQ, Ramos JD et al. Inflammatory bowel disease and pregnancy: report of two cases treated with infliximab and a review of the literature. Eur J Gastroenterol Hepatol. 2010;22:1260-4. PMID:20671559
9. 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
10. 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:

Prednisone

CAS Registry Number:

53-03-2

Drug Class:


  • Corticosteroids, Systemic


  • Administrative Information:




    LactMed Record Number:


    224


    Last Revision Date:


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