Is 11-beta,17,21-Trihydroxypregna-1,4-diene-3,20-dione Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use 11-beta,17,21-Trihydroxypregna-1,4-diene-3,20-dione? Is 11-beta,17,21-Trihydroxypregna-1,4-diene-3,20-dione safe for nursing mother and child? Does 11-beta,17,21-Trihydroxypregna-1,4-diene-3,20-dione extracts into breast milk? Does 11-beta,17,21-Trihydroxypregna-1,4-diene-3,20-dione has any long term or short term side effects on infants? Can 11-beta,17,21-Trihydroxypregna-1,4-diene-3,20-dione influence milk supply or can 11-beta,17,21-Trihydroxypregna-1,4-diene-3,20-dione decrease milk supply in lactating mothers?

Excreted into breast milk in non-significant amount with no problems reported in breastfed infants whose mothers were treated at a daily dose as high as 7.5 mg for a long time period. At a daily dose of 60 mg used for treatment of Herpes or Gestational Pemphigus no harm effects on breastfed infants have been reported. On long term treatments it would be advisable to wait for 3 - 4 hours until the next nurse to minimize the transfer of drug to breast milk. At high doses, intra-articular treatment with other steroid drugs (Triamcinolone) have transiently affected milk production. Steroids administered before delivery may delay initiation of phase II of Lactogenesis ("milk come in") and decrease milk production in the first postpartum week. Decreased production has been seen while taking Dexametasone. Steroid drugs are commonly used for Pediatric treatment with no side effects when infrequently used and for short-time periods. The American Academy of Pediatrics rates it compatible with breastfeeding. WHO Model List of Essential Medicines (2002) rates it compatible with breastfeeding

Amounts of 11-beta,17,21-Trihydroxypregna-1,4-diene-3,20-dione in breastmilk are very low. No adverse effect have been reported in breastfed infants with maternal use of any corticosteroid during breastfeeding. With high maternal doses, avoiding breastfeeding for 4 hours after a dose should markedly decrease the dose received by the infant. However, this maneuver is not necessary with short-term use. High doses might occasionally cause temporary loss of milk supply. Because absorption from the eye is limited, ophthalmic 11-beta,17,21-Trihydroxypregna-1,4-diene-3,20-dione would not be expected to cause any adverse effects in breastfed infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.

None reported with 11-beta,17,21-Trihydroxypregna-1,4-diene-3,20-dione or any other corticosteroid. In a prospective follow-up study, 6 nursing mothers reported taking prednisone (dosage unspecified) with no adverse infant effects.[5] There are several reports of mothers breastfeeding during long-term use of corticosteroids with no adverse infant effects: prednisone 10 mg daily (2 infants)[6][7] and 11-beta,17,21-Trihydroxypregna-1,4-diene-3,20-dione 5 to 7.5 mg daily (14 infants).[8] A woman who was nursing (extent not stated) her newborn infant was treated for pemphigus with oral 11-beta,17,21-Trihydroxypregna-1,4-diene-3,20-dione 25 mg daily, with the dosage increased over 2 weeks to 60 mg daily. She was also taking cetirizine 10 mg daily and topical betamethasone 0.1% twice daily to the lesions. Because of a poor response, the betamethasone was changed to clobetasol propionate ointment 0.05%. She continued breastfeeding throughout treatment and her infant was developing normally at 8 weeks of age and beyond.[9] A woman with pemphigoid gestationis was treated with 11-beta,17,21-Trihydroxypregna-1,4-diene-3,20-dione in a dosage tapering from 0.7 mg/kg daily to 1 mg daily during breastfeeding. She also received courses of intravenous immune globulin 2 grams/kg over 3 days at 4, 9 and 13 weeks postpartum. She breastfed her infant (extent not stated) for 3 months with no problems noted.[10] Two mothers with systemic lupus erythematosus were reported who took 11-beta,17,21-Trihydroxypregna-1,4-diene-3,20-dione 30 or 40 mg daily during pregnancy and lactation as well as tacrolimus 3 mg daily. Three years after birth, both children were healthy. The durations of lactation were not stated.[11]

Published information on the effects of 11-beta,17,21-Trihydroxypregna-1,4-diene-3,20-dione on serum prolactin or on lactation in nursing mothers was not found as of the revision date. However, medium to large doses of depot corticosteroids injected into joints have been reported to cause temporary reduction of lactation.[12][13][14] 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.[15] An equivalent dosage regimen of 11-beta,17,21-Trihydroxypregna-1,4-diene-3,20-dione 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.[16] An equivalent dosage regimen of 11-beta,17,21-Trihydroxypregna-1,4-diene-3,20-dione might have the same effect.