Is Triamcinolone Safe in Breastfeeding

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

A corticosteroid with a mainly glucocorticoid action and anti-inflammatory effects of similar strength to that of prednisolone.Systemic administration (oral, injection), inhaled (bronchial, nasal), intra-articular, intravitreous and topical.Indicated in the treatment of rheumatic diseases and collagen, inflammatory bowel disease, dermatitis, asthma, rhinitis, etc. This comment is about systemic, intra-articular and ophthalmic triamcinolone. Since the last update we have not found published data about its excretion in breast milk. Administration of intra-articular triamcinolone in the wrist (Smuin 2016) or via an epidural in the cervical area (McGuire 2012) caused a temporary decrease in the production of milk lasting between one and four weeks that was resolved in both cases via the continuation and stimulation of breastfeeding. The same has occurred, with a shorter duration, following the intra-articular administration of methylprednisolone (Babwah 2013). Although after the administration of triamcinolone, both intraocular (Shen 2010, Degenring 2004), and epidural (Hooten 2016), elimination half-life is about 22-25 days, plasma levels are indetectable or very low, not clinically significant. The maximum concentration peak after these types of administration occurs at 24 hours (Hooten 2016, Shen 2010, Degenring 2004). There is consensus among experts that, in general, neither systemic corticoids nor inhaled ones present a breastfeeding contraindication (National Asthma Education 2004). The low plasma levels obtained after ophthalmic administration suggest a very low risk during breastfeeding. Corticoids are of commonally used in pediatrics and have no side effects when they are used in isolation or in short-term treatments. Until there is more published data about this drug in relation to breastfeeding, alternatives with a safer known pharmacokinetic profile for breastfeeding may be preferable (greater protein binding, lesser half-life and less oral bioavailability), especially during the neonatal period and in case of prematurity. If used during breastfeeding it is advisable to monitor milk production. See below the information of these related products:

Because no information is available on the use of oral or injectable triamcinolone during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. However, use of triamcinolone as a nasal spray or local injections, such as for tendinitis, would not be expected to cause any adverse effects in breastfed infants. Reviewers and an expert panel consider inhaled and oral corticosteroids acceptable to use during breastfeeding.[1][2][3] Local injections, such as for tendinitis, would not be expected to cause any adverse effects in breastfed infants, but might occasionally cause temporary loss of milk supply. See also Triamcinolone, Topical.

None reported with any corticosteroid.

A mother was nursing her 14-month-old 3 to 7 times daily. She had 5.7 mg of betamethasone sodium phosphate and acetate mixture injected into her shoulder for bursitis with no effect on lactation. Four weeks later, she continued to have pain in her thoracic cervical regions and was diagnosed with neural sensitization. She had 80 to 120 mg of triamcinolone diacetate injected into her cervical and thoracic spine epidurally and into the facets. Three days later, she noticed a decrease in milk supply and a reduced ejection reflex which continued to worsen over the next 5 days. She began using a breast pump with frequent pumping and domperidone as a galactogogue. Her milk slowly increased over several days and was normal by 21 days after the injection when she stopped domperidone. At that time, her serum prolactin levels were elevated.[4] The decrease in the mother's milk supply was possibly caused by the corticosteroid injections. A dose of depot methylprednisolone injected into the wrist has also been reported to cause temporary cessation of lactation.[5] 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.[6] An equivalent dosage regimen of triamcinolone 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.[7] An equivalent dosage regimen of triamcinolone might have the same effect. A nursing mother who was 7 months postpartum had triamcinolone 40 mg injected into the first dorsal compartment of the wrist along with 2 mL of 1% lidocaine for de Quervain tenosynovitis. Twenty-four hours after the injection, the patient reported a 90% decrease in lactation as measured by breast pumping before and after the injection. She continued to pump her breasts and began taking fenugreek to stimulate lactation. Within 1 week, her milk supply increased by 50% and by 1 month after the injection, she was able to meet her infants breastfeeding needs.[8]