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Breastfeeding infant - prednisone, imuran, salofalk

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  • Breastfeeding infant - prednisone, imuran, salofalk

    Hi there, I have ulcerative colitis and am in the middle of a bad flare. My doctor has prescribed me the following medication

    -prednisone 30 mg tapering by 5mg per week after two weeks
    -azathioprine (imuran) 100 mg daily.
    - salofalk 4000 mg daily.

    I have also been prescribed sulfamethoxazole 800 mg twice daily for a bad case of acne but this medicine is something I am willing to stop if it means being able to continue nursing. The other medications are a must with the severity of my disease though.

    I am Concerned about the potential growth impact on my son from the prednisone, as well as the safety of the other meds. Very confused as I want to keep breastfeeding so badly, to provide my baby with protection against my disease but do not want to expose him to harmful toxins.
    Will it be safe to continue to nurse?
    Thanks
    Thanks

  • #2
    Dear Amandab,

    Small amounts of prednisone are transferred to the breast milk, although it is probably safe in breastfeeding. In small doses, most steroids are certainly not contraindicated in nursing mothers. Following administration, wait at least 4 hours if possible prior to feeding infant to reduce exposure. With high doses (>40 mg/day), particularly for long periods, steroids could potentially produce problems in infant growth and development, although we have absolutely no data in this area, or which doses would pose problems. Brief applications of high dose steroids are probably not contraindicated as the overall exposure is low. With prolonged high dose therapy, the infant should be closely monitored for growth and development.

    Azathioprine (Imuran) is a powerful immunosuppressive agent that is metabolized to 6-Mercaptopurine (6-MP). The transport of 6-mercaptopurine into human milk is apparently quite low. However, this is a strong immunosuppressant and some caution is still recommended if it is used in a breastfeeding mother. Monitor the infant closely for signs of immunosuppression, leukopenia, thrombocytopenia, hepatotoxicity, pancreatitis, and other symptoms of 6-mercaptopurine exposure. Your pediatrician may do a blood test periodically to monitor for complications. The risks to the infant are probably low. Recent long-term data suggest that the rate of infections in treated groups is no different from non-treated controls.

    Mesalamine (Salofalk) is an anti-inflammatory agent used in ulcerative colitis. It contains 5-aminosalicylic acid (5-ASA) and acteyl-5-ASA is its metabolite and has been found in breastmilk. Numerous reports suggest milk levels of 5-ASA are quite low, generally less than 10% of the maternal dose. However, at high doses (greater than 4500 mg), milk levels of 5-ASA and even salicylic acid could become signficiant. Watery diarrhea has been reported but this appears to be rare. Commonly used in many patients without reported complications. Observe infant for gastrointestinal symptoms. Mesalamine administered rectally is poorly absorbed systemically. Since, plasma levels are exceedingly low (<=2 ?g/mL) following rectal administration, breastmilk levels would be quite low as well.

    Sulfamethoxazole is a common and popular sulfonamide antimicrobial, commonly used in combination with trimethoprim. Secretion into human milk is considered minimal. Use with caution in weakened infants, premature infants, or neonates with hyperbilirubinemia. You did not say how old your infant is so if he is younger than one month of age and is jaundiced, sulfamethoxazole is not a good choice. If your infant is older then this drug appears to be compatible with breastfeeding.

    Sincerely,
    Cindy Pride, MSN, CPNP
    TTUHSC InfantRisk Center

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    • #3
      Apart from such medicinal agents its always good to eat healthy during nursing days. Every mother needs to know that fact that the nutrients she intake directly goes into child's mouth through milk so its better take care of what you eat during breast feeding.

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