Steroids are used in many different preparations and for a wide variety of clinical conditions. Most of the information in this section pertains to glucocorticoids. Preparations include intravenous, oral, topical, injected (intradermal, intralesional, intramuscular, intraarticular), inhaled, intranasal, ophthalmological. Glucocorticoids are naturally occurring in breast milk. No adverse effects have been reported in breastfed infants with maternal use of any corticosteroid during breastfeeding. Steroids are also commonly used for pediatric treatment with no side effects when used sparingly and for short periods of time. High doses steroids can cause a transient decrease in milk production. When antenatal corticosteroids are given in cases of preterm birth, lactogenesis II can be delayed (1). For all steroid preparations there is no absolute indication to pump and dump. See below for details regarding specific preparations.

For more detailed information and references on specific medications, please refer to LactMed, e-lactancia, Infant Risk, or Mother to Baby.

• Methylprednisolone/Solumedrol, dexamethasone/Decadron, prednisone, hydrocortisone/Solu-Cortef: These are commonly used IV glucocorticoids. At high doses, glucocorticoids can cause a transient decrease in milk production. In the Multiple Sclerosis literature, it has been found that with extremely large intravenous doses of methylprednisolone (1 gram/day), the relative infant dose was less than 1% even shortly after initiation of the drug. The drug was found in low levels in the breastmilk (2-6). Glucocorticoids that have been more extensively studied during lactation (methylprednisolone, prednisolone, prednisone) may be preferred until more information is known. Although not absolutely necessary, lactating individuals may consider holding off on giving their milk to the infant for 1-4 hours after treatment with a very high dose of IV glucocorticoid, out of an abundance of caution (2-6). The milk can be expressed and stored for later use in small increments. While lactating individuals should be engaged in shared decision making when prescribing high doses of IV glucocorticoids, there is no absolute indication to pump and dump.

• Prednisolone/Orapred, prednisone, methylprednisolone/Medrol, dexamethasone, hydrocortisone/Cortef: These are commonly used oral glucocorticoids. Experts consider oral, nasal, and inhaled corticosteroids safe during lactation (7, 8). There is no absolute indication to pump and dump with oral glucocorticoids.
• Fludrocortisone/Florinef: This is a mineralocorticoid and a derivative of hydrocortisone. The glucocorticoid effect of this medication is 15x more potent than hydrocortisone. No data is available for this medication; however, it is unlikely that the amounts in breastmilk are clinically high enough to cause adverse infants side effects at usual dosing. There is no absolute indication to pump and dump with the use of oral fludrocortisone.

• Hydrocortisone, betamethasone, triamcinolone, etc.: There are many formulations of topical steroids and these are 3 of the most commonly used options. An attempt should be made to use the lowest effective potency of steroid possible (9, 10). The most potent steroids used on large areas may cause systemic effects in the lactating individual, but there is a low chance that there will be significant transfer to or systemic effects in the breastfed infant (10). If topical steroids are used on the nipple or areola, it is especially important to use the lowest effective potency and minimize infant ingestion of the steroid containing topical product. There is no absolute indication to pump and dump with the use of topical corticosteroids.

Injected steroids can be used via intramuscular, intraarticular, intradermal, and intralesional routes.

• Hydrocortisone, betamethasone, triamcinolone/Kenalog, dexamethasone, methylprednisolone, etc: There are many formulations of injectable steroids and these are some of the most commonly used options. There are case reports of transient decrease in milk production following an injection for tenosynovitis and injection of Kenacort (11, 12). There is no absolute indication to pump and dump with the use of injected corticosteroids.

• Beclomethasone/Qvar, budesonide/Pulmicort, ciclesonide/Alvesco, fluticasone/Flovent, mometasone/Asmanex: Experts consider oral, nasal, and inhaled corticosteroids safe during lactation (7, 8). There is no absolute indication to pump and dump.

• Fluticasone/Flonase, betamethasone, budesonide/Pulmicort, momestasone/Asmanex, and beclomethasone/Qvar: Experts consider oral, nasal, and inhaled corticosteroids safe during lactation (7, 8). There is no absolute indication to pump and dump.

• Prednisolone/Pred Forte, loteprednol/Altrex/Lotemax, and fluorometholone/Flarex: Absorption from the eye is limited. There is no absolute indication to pump and dump with the use of ophthalmological corticosteroids.