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Hi. I would like to ask Dr Hale if this is ok with breastfeading? injection in thorasic spine. Thank you
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Dr. Hale and I have reviewed this question and unfortunately, there are no direct studies available that look at either of these drugs as injections in breastfeeding mothers but there are some statements that we can make with reasonable confidence. The dexamethazone molecule looks a lot like its sister drug, prednisone, and it is reasonable to assume that it behaves roughly the same way with regards to its transfer into milk. High doses of oral prednisone (120mg) do not produce significant levels in human milk, so it is likely that local dexamethazone injections will not make it into the milk either. However, a few studies show that large doses of other kinds of steroids injected directly into joints may make some people produce less milk overall. Your pediatrician should monitor the baby to make sure he or she is gaining weight appropriately. We classify dexamethazone as an L3 (out of 5)("Probably safe") with regards to its lactation safety profile, largely due to the lack of direct studies in the medical literature.
Ropivicaine is an anesthetic commonly used in epidurals for mothers delivering babies. In that context, the mother's milk contained approximately 1% of the medication that the mother received. This medication was consumed by the baby with no ill effects. Used as a small local injection, the amount of transfer is likely to be similar, but the initial dose will be far lower than an epidural. We classify ropivicaine as an L2 (out of 5)("Safer") with regards to its lactation safety profile.
The following references may be useful to your physician if he or she needs more information:
1. Matsota PK, Markantonis SL, Fousteri MZF, Pandazi AK, Manikis DE, Christodoulopoulou TC, Loizou MM, Kostopanagiotou GG. Excretion of ropivacaine in breast milk during patient controlled epidural analgesia after caesarean delivery. Regional Anesthesia Pain Medicine 2009;34:126-129.
2. Presnisone prescribing information, Roxane Laboratories.
3. McGuire E . Sudden loss of milk supply following high-dose triamcinolone (Kenacort) injection. Breastfeed Rev. 2012;20:32-4.
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.
Please call the InfantRisk center at (806)352-2519 if this does not answer your question.
-James Abbey, MD
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