Is Dexamethasone safe while breastfeeding?
Here is what LactMed, the Drugs and Lactation Database published by the U.S. National Institute of Child Health and Human Development (NICHD), reports about Dexamethasone. The text below is quoted from that source — it is not our own verdict.
Summary of use during breastfeeding
Little information is available on the use of systemic dexamethasone during breastfeeding. Short-term use of dexamethasone is unlikely to affect the breastfed infant. An alternate corticosteroid might be preferred for long-tern use. Local injections, such as for tendinitis, are not expected to cause any adverse effects in breastfed infants. Medium to large doses of corticosteroids, including dexamethasone, given systemically or injected into joints or the breast have been reported to cause temporary reduction of lactation. See also Dexamethasone, Topical.
Effects on the breastfed infant
No adverse reactions have been reported with any corticosteroid.
A retrospective cohort study compared the breastfeeding success among multiparous women with a vaginal delivery who received postpartum epidural analgesia. One group received 0.15% ropivacaine for analgesia and the other group received 0.15% ropivacaine plus 10 mg of dexamethasone. The epidural was continued for 48 hours. There were no significant differences in 1-minute Apgar scores, 5-minute Apgar scores, neonatal jaundice, hypoglycemia, or infection rates nor on neonatal hospital stay duration or neonatal intensive care unit admission rates.[1]
Effects on milk supply
Dexamethasone can cause a decrease in basal serum prolactin and thyrotropin-releasing hormone stimulated serum prolactin increase in nonnursing women.[2,3] Medium to large doses of corticosteroids given systemically or injected into joints or the breast have been reported to cause temporary reduction of lactation.[4-8]
A study of 46 women who delivered an infant before 34 weeks of gestation found that a course of another corticosteroid (betamethasone, 2 intramuscular injections of 11.4 mg of betamethasone 24 hours apart) given between 3 and 9 days before delivery resulted in delayed lactogenesis II and lower average milk volumes during the 10 days after delivery. Milk volume was not affected if the infant was delivered less than 3 days or more than 10 days after the mother received the corticosteroid.[9] An equivalent dosage regimen of dexamethasone might have the same effect.
A study of 87 pregnant women found that betamethasone given as above during pregnancy caused a premature stimulation of lactose secretion during pregnancy. Although the increase was statistically significant, the clinical importance appears to be minimal.[10] An equivalent dosage regimen of dexamethasone might have the same effect.
A woman with postpartum depression who was breastfeeding her 8-week-old infant was treated with endovascular embolization for a spinal-dural arteriovenous fistula. Following the procedure, she was treated with intravenous dexamethasone 4 mg every 8 hours for 5 days, followed by oral dexamethasone 12 mg daily in a tapering regimen. After stopping breastfeeding for 3 days after the procedure, she noted a decreased milk supply on restarting breastfeeding, and a complete cessation of milk production 11 days after the procedure. Several measures to increase milk supply, including domperidone, failed. Breastmilk production resumed 36 hours after discontinuing dexamethasone and reached normal production after 8 days. At hospital discharge, she was exclusively nursing her infant.[7]
A retrospective cohort study compared the breastfeeding success among multiparous women with a vaginal delivery who received postpartum epidural analgesia. One group received 0.15% ropivacaine for analgesia and the other group received 0.15% ropivacaine plus 10 mg of dexamethasone. The epidural was continued for 48 hours. At 24 hours postpartum, the dexamethasone group had lower blood levels of TNF-α, IL-6, and C-reactive protein, and higher levels of IL-10. The time to first breastfeeding was shorter in the dexamethasone group (38 vs. 52 minutes). The dexamethasone group also had a higher breastfeeding rate within 48 hours postpartum and a higher exclusive breastfeeding rate on day 7 postpartum. No differences in maternal adverse effects were seen.[1]
A study compared the use of intravenous dexamethasone 25 mg after birth and 24 hours later to dexamethasone 5 mg after birth and placebo 24 hours later following cesarean section for pain control. Seventy-two of 105 mothers in each group breastfed their infants, with no difference in Bristol breastfeeding assessment tool scores over the first 4 days postpartum.[11]
Levels in milk
Maternal Levels. Relevant published information was not found as of the revision date.
Infant Levels. Relevant published information was not found as of the revision date.
Alternatives LactMed lists
Dexamethasone in pregnancy
LactMed covers breastfeeding only. For what the NHS and the US prescribing label say about pregnancy, see:
Source: Drugs and Lactation Database (LactMed), National Institute of Child Health and Human Development (NICHD), via NCBI Bookshelf, record “Dexamethasone” (LM86). LactMed on NCBI Bookshelf. LactMed is a registered trademark of the U.S. Department of Health and Human Services.
Educational summary of an authoritative source — not medical advice. Never start, stop, or change a medicine while breastfeeding without confirming with your doctor.