Dr. Brian Staiger asked
Can I breastfeed while taking prednisone?
Answer
The American Academy Of Pediatrics (AAP) classifies prednisone as "generally considered compatible for use during lactation". The professional consensus is that there is little risk nursing while taking prednisone as there have been no reports of adverse effects in infants. Having said this, prednisone, which converts to the drug prednisolone as it is metabolized in the body, is present in the breast milk at low concentrations after dosing. There have been a few studies on exactly how much prednisolone is present in breast milk which we will explore below.
Remember that prednisone is converted to prednisolone in the body so from this point forward, we are going to be referencing prednisolone levels in the breast milk. Now, let's look at two studies that measured the amount of the drug in breast milk after dosing.
A study titled 'Prednisolone Excretion in Human Milk' determined that after a dose of 80mg of prednisone, an infant would be exposed to less than 0.1% of that dose, or 0.08 mg. To put that in perspective, that corresponds to less than 10% of the infants own cortisol (a steroid) production. The study concluded that prednisone does appear to be safe to take during breastfeeding but exposure can be minimized even more if you wait at least 4 hours after taking a dose.
A different study, titled 'Secretion Of Prednisolone Into Breast Milk', found similar results. While the study referenced above found about 0.1% of the maternal dose in the breast milk, this study found that 0.07% to 0.23% of the dose was present in the breast milk. This study concluded that prednisone during breastfeeding was likely OK due to the low concentrations found and limited exposure to the infant.
Furthermore, according to the National Institutes of Health, no changes or avoidance of breast feeding is necessary with short term use of prednisone. Due to the lack of information on the effects of prolonged use with high doses (>40 mg per day) it is recommended to wait at least 4 hours after dosing to limit exposure to the infant.
So in summary, short term use of prednisone while breastfeeding appears to be OK. There has been little to no reports of adverse events in infants. Both the American Academy of Pediatrics and the National Institutes of Health consider short therapy of prednisone to be safe. If you do want to limit as much exposure as you can, wait at least 4 hours after dosing prednisone before breastfeeding.
