Is Dexamethasone, Topical Safe in Breastfeeding

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

Pharmacokinetic data indicate that excretion into breast milk in significant levels is possible, hence for long term treatments other steroids with lower excretion would be advisable. Other steroids (Betamethasone) that are administered prior to delivery can produce a delay of Lactogenesis phase II (milk's coming in) and a decrease of milk production within the first post-partum week. Intra-articular injected large doses of other steroids (Triamcinolone, Methylprednisolone) may transiently affect milk production. A decrease of prolactin release after administration of dexamethasone has been observed that may decrease milk production mostly in the first post-partum weeks. Topical use: Because of a low absorption through skin significant excretion into breast milk is unlikely. Additionally, a high protein binding makes excretion even more unlikely. Whenever a treatment for nipple eczema or dermatitis is required the lowest potency steroid compound should be used. It should be applied right after the feed to make sure it has disappeared before the next nursing occurs. Otherwise, wipe cream out with a clean gauze. Do not continuously use for longer than a week. Reportedly, a case of mineral-steroid toxicity has occurred due to continuous use of cream on the nipple. Creams, gels or similar products that contain paraffin or mineral oil should not be used on the nipple to avoid absorption by the infant. Corticoids are frequently prescribed in Pediatrics with no side effects on the infant when indicated for short-term or sporadical use. On nursing mothers a timely use or not long-term treatment is compatible with breastfeeding along with the assessment of milk production. WHO Model List of Essential Drugs 2002: Compatible with breastfeeding in single dose. No data is available on long-term use.

Topical dexamethasone has not been studied during breastfeeding. Since only extensive application of the most potent corticosteroids 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 (e.g., hydrocortisone, triamcinolone) 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. Because absorption from the eye is limited, ophthalmic dexamethasone 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.

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]