Betamethasone

Betamethasone

Corticoid of high anti-inflammatory power (25 times more than hydrocortisone) with main effect glucocorticoid and almost zero mineralocorticoid. Oral, parenteral (iv, im, intra- articular, intra-lesional), topical (dermatological, otic and ophthalmological) and inhalatory administration. Authorized use in children under one year of age.

At the date of the last update, the authors did not find any published data on its excretion in breast milk.

Its pharmacokinetic data make the transition to milk likely in an amount that could be significant, so in prolonged treatments it is advisable to use corticosteroids known for their poor transition to milk.

SYSTEMIC USE: ORAL, IM, IV, INTRA-ARTICULAR, INTRALESIONAL

Administered in prepartum, it can cause delay in lactogenesis II (raising/lowering of milk) and decrease the amount of milk in the first week ^{(Henderson 2008)}. Other corticosteroids such as dexamethasone may cause a decrease in prolactin, which could decrease milk production especially during the first few weeks ^{(Hubina 2002, Risch 1987)}. Large intra- articular doses of other corticosteroids (methylprednisolone, triamcinolone) may transiently affect milk production ^{(Babwah 2013, McGuire 2012)}. Intra-articular injection of betamethasone did not cause a decrease in milk production. ^{(McGuire 2012)}

Corticosteroids are commonly used in pediatrics and have no side effects when used alone or in short treatments.

In breastfeeding mothers, the occasional use and not prolonged treatment is compatible with breastfeeding by monitoring milk production.

TOPICAL USE: DERMATOLOGICAL, OTOLOGICAL, OPHTHALMOLOGICAL, INHALED

The small dose and poor plasma absorption of most topical preparations (nasal, ophthalmological, otological, dermatological ^{(Leo 2011)} or inhaled) make the transition from significant amount to breast milk very unlikely.

If corticosteroids are required to treat eczema or dermatosis of the nipple, it is advisable to choose a less powerful corticosteroid ^{(Barrett 2013)}, apply it just after the feeding so that it has been reabsorbed before the next one and, if necess^{ary, remove remains with a gauze and do not use for more than 10 days in a row.} (Amir 1993)

Preparations containing betamethasone, mupirocin and miconazole are not superior to lanolin creams in treating pain, cracks and swelling of the nipple. ^{(Dennis 2012)}

Mineral-corticoid poisoning has occurred in an infant by continuous application of a corticosteroid to the nipple. ^{(De Stefano 1983)}

Creams, gels and other topical products containing paraffin (mineral oil) should not be applied to the nipple so that they are not absorbed by the infant. ^{(Concin 2008, Noti 2003)}

List of essential medicines WHO 2002: topical use compatible with breastfeeding. ^{(WHO 2002)}