Is Fluticasone, Topical Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Fluticasone, Topical? Is Fluticasone, Topical safe for nursing mother and child? Does Fluticasone, Topical extracts into breast milk? Does Fluticasone, Topical has any long term or short term side effects on infants? Can Fluticasone, Topical influence milk supply or can Fluticasone, Topical decrease milk supply in lactating mothers?

At latest update no relevant data on this subject were found in connection with breastfeeding, however, its low systemic absorption rate with a high plasma protein-binding capacity makes that excretion into breast milk may be very unlikely. Experts on this field consider topical, oral or inhaled steroids compatible with breastfeeding. At usual dose of oral, inhaled (nasal or pulmonary) or dermatologic preparations are used, absorption is very low with non-significant levels achieved in plasma serum. Whenever a treatment for eczema or dermatitis of the nipple is required, the least potent preparation should be used. Apply after a breast feed to let it to disappear before the next feed. Clear out excess of cream with a gauze when indicated. Avoid continuous use for longer than a week. Steroid toxicity has occurred in an infant after continuous use of steroidal cream on the nipple. Avoid use of creams, gels and other topical medication containing paraffin (petroleum-derived mineral oil) in order to avoid the risk of absorption by the child.

Topical fluticasone has not been studied during breastfeeding. Since only extensive application of the most potent corticosteroids may cause systemic effects in the mother, it is unlikely that short-term application of topical corticosteroids would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only the lower potency corticosteroids should be used on the nipple or areola where the infant could directly ingest the drugs from the skin. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.[1] Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area.

Topical application of a corticosteroid with relatively high mineralocorticoid activity (isofluprednone acetate) to the mother's nipples resulted in prolonged QT interval, cushingoid appearance, severe hypertension, decreased growth and electrolyte abnormalities in her 2-month-old breastfed infant. The mother had used the cream since birth for painful nipples.[2]