Cortisone shot for carpal tunnerl

[Yana Mikhaylov]

great thank you so much!

[admin]

Yana:

Not really a lot of research on steroid levels in milk, except all the prior studies suggest milk levels of corticosteroids are extremely low. We published a study with intravenous doses of 1000 mg methylprednisolone in a mother. Levels in milk after about 8 hours were quite safe. Thus, we still say that acute high dose steroids probably produces minimal levels in milk. In your case with a 9 month old infant, and reduced milk production per day, I'd suggest the risk is really quite minimal to nil.

Tom Hale Ph.D.

[admin-james]

Other medications may be better studied, but the assumption that Kenalog behaves similarly to cortisone is a reasonable one. Not much of anything injected into a joint makes it into the circulation anyway, certainly not quickly. Choosing a treatment method that the prescribing physician is comfortable / familiar with will give it a better chance of success. Let's revisit this issue if her conversation with her doctor prompts a further question.

[LopezMendoza]

Hello Drs. Hale and Abbey - this is timely because I just had a patient today (I am an IBCLC) who asked exactly the same question. She has not yet had her injection, but I looked it up in MMM and found only the cortisone topical listed in 2012 edition. I will ask her to ask her doctor which medications are going to be used in the injection and give her this information. Do either of you have suggestions of lactation - friendly cortisone shot cocktails or other treatments? her baby is 5 weeks old, thriving, she is a writer and is anxious to get back to her computer. thank so much!
Lopez Mendoza

[admin-james]

Hi Aporia, thanks for your post.

Your doctor probably used a combination of Kenalog (triamcinolone) and Marcaine (bupivacaine) on your wrist. That's a popular cocktail for joint injections. Marcaine is a local anesthetic that is also used in epidural anesthesia for mothers giving birth. In that context, which involves doses much larger than you got in your hand, it is difficult to even find the drug in the breastmilk and no side effects have been reported in breastfeeding infants. We give it an L2 (out of 5) ("Probably safe") with regards to its lactation safety.

Kenalog is a steroid that helps with inflammation. Studies on injections into joints show that the drug leaks out over the course of weeks and results in only minimal drug levels in the blood. No satisfactory studies have been done about how much gets into the milk, but it is expected to be quite low. We give it an L3 (out of 5) ("Probably compatible") with regards to its lactation safety, principally because of the lack of direct studies.

Please call us at the InfantRisk Center if this has not completely answered your question. (806)352-2519

-James Abbey, MD
and
-Thomas W. Hale, Ph.D.

[Aporia]

I have carpal tunnel and needed to have an injection into my wrist to help alleviate the pain. My doctor said that he was pretty sure it was compatible with nursing but I wanted to ask just to put my mind at ease. My infant is 7 months old and nurses on demand. I received the shot this morning at 10am. Have I exposed her to something extremely bad by nursing her as soon as I got home? Should I avoid nursing and give formula for X amount of hours? I'm not sure what the medicines were, I thought they said kelog and melocain but I can't seem to find any of those medicines online when I search. Any information would be greatly appreciated. thank you in advance!