Dexamethasone use while Breastfeeding

Summary of Use during Lactation

Because little information is available on the use of systemic dexamethasone during breastfeeding, an alternate corticosteroid may be preferred, especially while nursing a newborn or preterm infant. Local injections, such as for tendinitis, would not be expected to cause any adverse effects in breastfed infants. Medium to large doses of corticosteroids, including dexamethasone, given systemically or injected into joints or the breast have been reported to cause temporary reduction of lactation. See also Dexamethasone, Topical.

Drug Levels

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

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

Effects in Breastfed Infants

None reported with any corticosteroid.

Effects on Lactation and Breastmilk

Dexamethasone can cause a decrease in basal serum prolactin and thyrotropin-releasing hormone stimulated serum prolactin increase in nonnursing women.[1,2] Medium to large doses of corticosteroids given systemically or injected into joints or the breast have been reported to cause temporary reduction of lactation.[3-7]

A study of 46 women who delivered an infant before 34 weeks of gestation found that a course of another corticosteroid (betamethasone, 2 intramuscular injections of 11.4 mg of betamethasone 24 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.[8] An equivalent dosage regimen of dexamethasone might have the same effect.

A study of 87 pregnant women found that betamethasone given as above during pregnancy caused a premature stimulation of lactose secretion during pregnancy. Although the increase was statistically significant, the clinical importance appears to be minimal.[9] An equivalent dosage regimen of dexamethasone might have the same effect.

A woman with postpartum depression who was breastfeeding her 8-week-old infant was treated with endovascular embolization for a spinal-dural arteriovenous fistula. Following the procedure, she was treated with intravenous dexamethasone 4 mg every 8 hours for 5 days, followed by oral dexamethasone 12 mg daily in a tapering regimen. After stopping breastfeeding for 3 days after the procedure, she noted a decreased milk supply on restarting breastfeeding, and a complete cessation of milk production 11 days after the procedure. Several measures to increase milk including domperidone supply failed. Breastmilk production resumed 36 hours after discontinuing dexamethasone and reached normal production after 8 days. At hospital discharge, she was exclusively nursing her infant.[6]

Alternate Drugs to Consider

(Systemic) Methylprednisolone, Prednisolone, Prednisone

References

1.

Hubina E, Nagy GM, Toth BE, et al. Dexamethasone and adrenocorticotropin suppress prolactin secretion in humans. Endocrine 2002;18:215-9. [PubMed: 12450312]

2.

la Marca A, Torricelli M, Morgante G, et al. Effects of dexamethasone and dexamethasone plus naltrexone on pituitary response to GnRH and TRH in normal women. Horm Res 1999;51:85-90. [PubMed: 10352398]

3.

McGuire E. Sudden loss of milk supply following high-dose triamcinolone (Kenacort) injection. Breastfeed Rev 2012;20:32-4. [PubMed: 22724311]

4.

Babwah TJ, Nunes P, Maharaj RG. An unexpected temporary suppression of lactation after a local corticosteroid injection for tenosynovitis. Eur J Gen Pract 2013;19:248-50. [PubMed: 24261425]

5.

Smuin DM, Seidenberg PH, Sirlin EA, et al. Rare adverse events associated with corticosteroid injections: A case series and literature review. Curr Sports Med Rep 2016;15:171-6. [PubMed: 27172081]

6.

Das N, Dave S, Dangaich R, et al. Lactation failure following therapeutic steroid treatment in a mother with postpartum depression and spinal-dural arteriovenous fistula: Case report and literature review. Int J Gynaecol Obstet 2024;165:389-91. [PubMed: 38093554]

7.

Rosen-Carole C, Datta P, Palmiter K, et al. Transfer of injected triamcinolone into human milk of a lactating patient suffering from idiopathic granulomatous mastitis. Breastfeed Med 2023;18:74-7. [PubMed: 36638194]

8.

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. [PubMed: 18166549]

9.

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. [PubMed: 19772378]

Substance Name

Dexamethasone

CAS Registry Number

50-02-2

Drug Class

Breast Feeding

Lactation

Milk, Human

Corticosteroids, Systemic

Glucocorticoids

Anti-Inflammatory Agents