Last update June 13, 2021
Very Low Risk
Prednisone is a biologically inert corticosteroid that is metabolized in the liver to its active form, prednisolone, with primarily glucocorticoid effects.
Oral and ophthalmic administration.
It is excreted in breast milk in clinically insignificant amount (Ryu 2018, Berlin 1979, Katz 1975) and no problems reported in breastfed infants whose mothers were treated at a daily dose as high as 10 mg for a long time period (Constantinescu 2014, Correia 2010, Moretti 2003, Muñoz 2001, Nyberg 1998, Ito 1993). At a daily dose of 60 mg no harm effects on breastfed infants have been reported (Correia 2010).
On long term treatments or in high doses some authors recommend to wait for 4 hours until the next nurse to minimize the transfer of drug to breast milk (Sammaritano 2020 & 2014, Götestam 2016, van der Woude 2015 & 2010, Durst 2015, Huang 2014, Bae 2012, Habal 2012, Van Assche 2010, Heetun 2007).
At high doses, intra-articular treatment with other steroid drugs (Methylprednisolone, Triamcinolone) have transiently affected milk production (Babwah 2013, McGuire 2012).
Steroids administered before delivery may delay initiation of phase II of Lactogenesis ("milk come in") and decrease milk production in the first postpartum week (Henderson 2008).
Steroid drugs are commonly used for Pediatric treatment with no side effects when infrequently used and for short-time periods.
Several medical societies, experts and expert consensus, consider the use of prednisone/prednisolone to be safe during breastfeeding (LactMed, Hale, Nguyen 2016, Götestam 2016, Flint 2016, Noviani 2016, Shah 2016, McConnell 2016, Bordini 2016, Huang 2016 & 2014, Briggs 2015, Schaefer 2015, van der Woude 2015 & 2010, Durst 2015, Yarur 2013, Bae 2012, Habal 2012, Jain 2011, Van Assche 2010, Mottet 2009, Heetun 2007, N.Asthma 2004, Janssen 2000, Goldsmith 1989, Needs 1985).
American Academy of Pediatrics: medication usually compatible with breastfeeding (AAP 2001).
List of WHO essential medicines: compatible with breastfeeding (WHO / UNICEF 2002).
Ophthalmic administration is fully compatible with breastfeeding.
We do not have alternatives for Prednisone since it is relatively safe.
Suggestions made at e-lactancia are done by APILAM team, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it.
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