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I'm currently having vision problems, possible optic neuritis, again! My neuro wants me to do 3 days of high dose iv steroids and then 14 days of oral steroids, prednisone, starting at 100mg and tapering Off each day. My lactation consultant told me once I was done with the iv I'd be OK to continue nursing on day 4. Just wondering if anyone has gone thru this and any advice on the situation would be greatly appreciated!!!
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A couple of questions for you:
1. Will you be taking the oral steroids once per day or spreading the dose out?
2. Have you been pumping? If so, how much of a "stockpile" do you think you could put aside before starting the steroids?
-James Abbey, MD -
1. I'll be taking it once per day for 14 days.
2. I do have stored breastmilk, I'd say about 5 days worth.Comment
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Prednisone and its primary metabolite reach peak concentration in the blood around 2 hours after you take the dose and decreases by half every two hours after that. We do not have solid data on what dose of oral steroids is "safe" for a breastfeeding, but we know that the average infant receives 2-5% of the mother's dose in the breastmilk. There have been multiple reports of women breastfeeding long-term on <40mg/day with no problems. I would like to recommend the following:
1. Do not breastfeed while on IV steroids. Use your stored milk.
2. Make a point of feeding or pumping just before or just after you take your oral dose. This is when you will have the lowest concentration of steroid in the blood. The steroid will not have time to enter the breastmilk if you complete the process within 30 minutes of taking your pills.
3. While taking between 100 and 61mg/day, wait 4 hours after your dose, pump and discard your milk, then breastfeed freely.
4. While taking between 60 and 31mg/day, wait 2 hours after your dose, pump and discard your milk, then breastfeed freely.
5. While taking <31mg/day, breastfeed freely.
6. Make an appointment with your pediatrician around day 7 of your steroid taper to have your baby checked out for any potential problems. The first sign of trouble will probably be poor weight gain. Any side effects will be fully reversible at that point.
This regimen will theoretically expose your baby to no more than 20 micrograms/day of steroid. I think this is a reasonable compromise that should allow you to continue breastfeeding without interruption.
Please call us at the InfantRisk Center if this has not completely answered your question.*(806)352-2519
-James Abbey, MDComment
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