Prednisone is a commonly prescribed corticosteroid used to treat various inflammatory and autoimmune conditions, such as severe allergies, asthma, and lupus. New mothers needing this medication often worry if it is safe to continue breastfeeding, as many drugs can transfer through breast milk and potentially affect the nursing infant. Understanding how prednisone works and its minimal transfer into milk can guide safe use during lactation.
Why Prednisone Is Considered Low Risk
Prednisone is generally considered compatible with breastfeeding because only a very small amount of the drug and its active form reach the infant. Prednisone is a prodrug, meaning it is inactive until the mother’s liver converts it into its active metabolite, prednisolone. Prednisolone is the substance that enters the breast milk.
The amount of prednisolone that transfers into the milk is minimal, especially at standard therapeutic doses, typically below 40 milligrams per day. Studies calculating the Relative Infant Dose (RID) show that the infant ingests less than one percent of the mother’s weight-adjusted dose. This exposure is often far less than the natural cortisol the infant’s own body produces daily.
Reputable resources like the Drugs and Lactation Database (LactMed) categorize prednisone as low risk for breastfed infants. No adverse effects have been reported in infants whose mothers were taking standard doses. Even with higher doses, the majority of the drug remains bound to plasma proteins in the mother’s bloodstream, limiting the amount available to pass into the milk.
Although the risk is low, high-dose or long-term use (over 40 mg/day) warrants close consultation with a physician. The theoretical concern with excessive exposure is the possibility of temporary adrenal suppression in the infant, affecting the baby’s ability to produce its own stress hormones. Even in studies involving high-dose maternal use during pregnancy, evidence of prolonged adrenal issues in newborns has been difficult to establish.
Practical Dosing Strategies for Nursing Mothers
Nursing mothers can adopt specific strategies to minimize the already low infant exposure to prednisone. The goal is to administer the medication when the drug concentration in the mother’s milk will be lowest during the next feeding. This approach allows mothers to maintain their treatment while maximizing infant safety.
The most effective strategy is timing the dose to coincide with the infant’s longest sleep period, typically immediately after the longest feeding session or just before a long stretch of sleep. This allows the peak concentration of the drug in the mother’s blood and milk to occur when the infant is not feeding. Peak levels of prednisone and prednisolone in breast milk typically occur one to two hours after the mother takes the dose.
If a mother is taking a high dose (over 20 milligrams daily), a physician might suggest waiting a short period before the next feeding. Waiting approximately three to four hours after taking the dose allows drug levels in the milk to decline significantly before the infant nurses again. For mothers taking standard low doses, this waiting period is often unnecessary, as exposure remains minimal.
The practice of “pumping and dumping” is usually not necessary for mothers taking standard doses of prednisone. This technique, which involves discarding milk expressed after a dose, is typically reserved for situations where a medication is contraindicated for breastfeeding or if the dose is extremely high. For most mothers, focusing on the timing of the dose is a sufficient and practical strategy.
Signs to Monitor in the Breastfed Infant
While the risk to the infant from prednisone is minimal, mothers should observe their baby for any unusual changes suggesting drug exposure. The pediatrician is the best resource for monitoring and addressing concerns during treatment.
Mothers should pay close attention to the infant’s growth patterns, looking for signs of poor weight gain or failure to thrive, which are rare indicators of systemic effects. Any noticeable developmental delays should be reported to a healthcare provider immediately. These concerns relate to the theoretical risk of adrenal suppression, where high levels of the medication could suppress the baby’s own hormone production.
Potential signs might include minor behavioral changes like increased irritability or altered sleep patterns. Another side effect to monitor is the development of oral thrush, or candidiasis, which is a fungal infection that can sometimes occur with steroid use. If any of these symptoms or a change in feeding habits is observed, the mother should contact the prescribing physician or the baby’s pediatrician promptly.
Taking prednisone as prescribed is compatible with breastfeeding and is far safer than leaving a serious medical condition untreated. The importance of maintaining maternal health for effective infant care outweighs the negligible risk posed by the medication. Close communication with both the prescribing doctor and the infant’s pediatrician ensures that treatment is optimized for both mother and child.