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Prednisone 50mg for several weeks: safe to nurse?

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  • Prednisone 50mg for several weeks: safe to nurse?

    Dr. Hale,

    I have severe allergic contact dermatitis and need to take prednisone to clear it up. I am nursing my 10 month old every 2 hours around the clock. She has little interest in solids so far, so she is nearly exclusively breastfed. There is occasionally a 3 hour stretch between feedings during the day, but it is unpredictable.*

    A few weeks ago I was prescribed a 15 day tapering course starting at 50mg. I saw a dramatic improvement for the first 3 days when I was on 50mg, but when it dropped to 40mg my condition got worse. My doctor prescribed another identical course with the same results. (I think I may have still been in contact with the allergen at the time. I'm hopeful that we have recently found the culprit - a formula change in my laundry detergent.)

    I'm now seeing a new doctor who wants to keep me at a high dose for a longer period. I don't know the exact dose until my appointment this week, but based on our conversation I'd imagine it would be in the 50-60mg range for a few weeks since we know 40mg wasn't effective.

    Is it safe to continue nursing my daughter? I am concerned about taking such a high dose for so long.*

    Is there an alternate medicine that might be safer?

    And finally, does it change the risk or effectiveness if I take the dose all at once vs. three smaller doses per day?

    Thank you so much!

  • #2
    Hi, thanks for your post.

    Our assessment of prednisone is that long-term use of prednisone >40mg per day poses a *theoretical* risk to the infant, but there are no direct studies available to verify this. You can reduce this risk substantially by doing the following:

    1. 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.
    2. Wait 4 hours after your dose, pump and discard your milk, then breastfeed freely for the rest of the day. This delay reduces your baby's exposure to prednisone by 50-75%

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

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