Safety of Prednisone injection

[smoncada]

Good morning. I have RA and my disease is well controlled in terms of my CRP and labs, but not my symptoms. I was on 2.5 mg prednisone during pregnancy. After the baby was ~two months, I bumped to 5mg and then to 10 mg. When the baby was around 7.5 months old I started Humira. Humira helped some and I was wanting to lower my prednisone due to irritability. I lowered my prednisone back down to 2.5 mg. I have a fair amount of pain in my feet due to inflammation. Injections of cortisone are not an option, I did do that when baby was about 2.5 months and that helped for a few months. I unfortunately have damage in my feet. I have also developed new rheumatoid nodules in the past few months, which of course concerned my doctor. The Rheumatologist suggested an injection of prednisone that I believe she said is stored in the fat cells for a longer time and is a higher dose, like maybe 50 or 75 mg. The doctor said she doesn't know the amount that the baby, now almost 10 months would absorb or how long the prednisone would stay in my system/transfer into the milk. I am currently taking a weekly Humira injection and daily prednisone 2.5 mg. My questions are,

for a 10 month old who nurses ~7 to 11 times in 24 hours, how safe is a prednisone injection into my fat cells, I believe into my butt is the injection site, hopefully I am correctly stating "fat cells", as I am going off memory

would there be a consideration in 50mg vs. 75 mg for this injection?

would a tapering oral course of prednisone be preferred to the injection?

Does the safety of Humira change from injecting every week vs. every two weeks?

Does the injection form of prednisone usually have the same side effects as oral prednisone, particularly I am asking about the mood swings/irritability?

I would like to continue nursing maybe until 18 months, do the benefits of continuing to breastfeed longer 18 months versus 12 months outweigh the medication risks of continuing on weekly Humira? I am not sure if I will continue prednisone.

Thank you you so much for your feedback and maintaining these forums.

[admin]

smoncada,

Prednisone is rated an L2-limited data-probably compatible. The amount that transfers into breast milk is 1.8-5.3% of your dose. Steroids are usually ok as long as they are not used in high doses for prolonged periods of time. We do recommend waiting at least 4 hours for doses greater than 40mg.

We believe both the oral or injectable forms are ok to use. We would recommend using whichever form your Dr thinks would be most beneficial for your situation.

Humira is rated an L3-limited data-probably compatible. The amount that transfers into breast milk is 0.12% of your dose. "Although the molecular weight of this medication is very large and the amount in breastmilk is very low, there are no long term data concerning the safety of using immune modulating medications in breastfeeding mothers. Further there are current data that suggest that some IgG drugs do transfer into milk, and perhaps the breastfed infant. Therefore, some caution is recommended and each woman should understand the benefits and risk of using this type of medication in lactation." (Medications and Mothers' Milk database, Thomas Hale PhD). We believe the risk is low as long as the infant is not symptomatic, monitor for frequent infections, fever, vomiting, and make sure your infant is gaining weight appropriately.

The majority of antibodies are transferred in the last trimester of pregnancy and the first 6 months of breastfeeding, but breastfeeding for at least a full year is recommended. The risk of the medication vs the benefits of breastfeeding is the decision each mother needs to make with their Dr.

Sandra Lovato R.N.
InfantRisk Center
806-352-2519