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Hi, I was recently diagnosed with Mixed Connective Tissue Disease which my rheumatologist believe is the early stages of Lupus. As I am currently dealing with crippling total body joint and muscle pain, he prescribed Prednisone (15mg week 1, 10mg week 2, 5mg week 3) and ongoing Plaquenil (200mg). He said that the Plaquenil was not an issue for breastfeeding but the steroid would peak at 4 hours after ingestion in the breast milk and said to pump and dump at 4 hours. My plan was to pump around 3 hours after taking the medicine and then pump at 4.5 hours and dump that. Is this ok? or is the milk pumped at 3 hours not ok for baby's consumption? Thanks for your help, Jenna
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Jenna:
Prednisone is rapidly converted to prednisolone, which is the active form. The Time to maximum level in plasma is 1.5 to 1.67 hours depending on the dose. This is when you might want to avoid breastfeeding. It has a short half-life of 2.37 to 3.38 hours. Thus 50% would be gone at these two times.
At these doses (5-15 mg per day), I don't think you necessarily even need to stop breastfeeding at, particularly since the dose that enter milk is only about 1.8% - 5.3% of the maternal dose.
But if you want to avoid the peak, I'd suggest you breastfeed, take the medicine, then wait 3-4 hours. This will greatly reduce the exposure of your infant (which is still negligible).
Regards
Tom Hale Ph.D.
Professor
InfantRisk Center
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[URL="http://www.ncbi.nlm.nih.gov/pubmed/9505983#"]J Clin Pharmacol.[/URL] 1997 Oct;37(10):916-25.
Pharmacokinetics of methylprednisolone and prednisolone after single and multiple oral administration.
[URL="http://www.ncbi.nlm.nih.gov/pubmed/?term=Rohatagi%20S%5BAuthor%5D&cauthor=true&cauthor_uid=9505983"]Rohatagi S[/URL]1, [URL="http://www.ncbi.nlm.nih.gov/pubmed/?term=Barth%20J%5BAuthor%5D&cauthor=true&cauthor_uid=9505983"]Barth J[/URL], [URL="http://www.ncbi.nlm.nih.gov/pubmed/?term=M%C3%B6llmann%20H%5BAuthor%5D&cauthor=true&cauthor_uid=9505983"]Möllmann H[/URL], [URL="http://www.ncbi.nlm.nih.gov/pubmed/?term=Hochhaus%20G%5BAuthor%5D&cauthor=true&cauthor_uid=9505983"]Hochhaus G[/URL], [URL="http://www.ncbi.nlm.nih.gov/pubmed/?term=Soldner%20A%5BAuthor%5D&cauthor=true&cauthor_uid=9505983"]Soldner A[/URL], [URL="http://www.ncbi.nlm.nih.gov/pubmed/?term=M%C3%B6llmann%20C%5BAuthor%5D&cauthor=true&cauthor_uid=9505983"]Möllmann C[/URL], [URL="http://www.ncbi.nlm.nih.gov/pubmed/?term=Derendorf%20H%5BAuthor%5D&cauthor=true&cauthor_uid=9505983"]Derendorf H[/URL].
[URL="http://www.ncbi.nlm.nih.gov/pubmed/9505983#"]Author information[/URL]
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Abstract
The pharmacokinetics of methylprednisolone and prednisolone were evaluated in 24 healthy men after oral administration of single and multiple doses for 3 days. For each drug, 6 different administration regimens with doses ranging from 1 to 80-mg of methylprednisolone and 1.25 to 100-mg ofprednisolone, and administration intervals ranging from 3 to 24 hours for both were investigated. Plasma was assayed using a normal phase high-performance liquid chromatography (HPLC) method. Methylprednisolone showed linear pharmacokinetics with no apparent dose or time dependency.Prednisolone showed marked dose dependency with higher clearance and volume of distribution for higher doses. This can be explained by its saturable protein binding of plasma, because unbound clearance and unbound volume of distribution were not dose-dependent. After multiple administration, prednisolone showed significant time-dependent pharmacokinetics with increased unbound clearance and increased unbound volume of distribution. Due to the complicated pharmacokinetic properties of prednisolone, it is extremely difficult to determine the dose needed to obtain a desired target concentration. The pharmacokinetics of methylprednisolone are more predictable because methylprednisolone concentrations are proportional to dose, and no determination of plasma protein binding is needed.
[COLOR=#575757][FONT=arial][SIZE=13px] PMID: 9505983 [PubMed - indexed for MEDLINE] [/SIZE][/FONT][/COLOR]
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