Safest Corticosteroids for Breastfeeding Mothers

Preferred Corticosteroids During Lactation

The American College of Rheumatology recommends prednisone ≤20 mg daily (or equivalent non-fluorinated glucocorticoid) as compatible with breastfeeding, with minimal excretion into breast milk, approximately 10% of the maternal dose reaching the infant 1, 2, 3
The European League Against Rheumatism (EULAR) guidelines support low-dose glucocorticoid therapy as generally safe during lactation, with the American College of Rheumatology also endorsing this approach 1, 2, 3

Methylprednisolone is a reasonable alternative to prednisone/prednisolone, with similar safety profiles during lactation and approximately 10% of the maternal dose available to the infant 2, 3
Hydrocortisone is classified as compatible with breastfeeding and may be used when parenteral administration is necessary, according to the European Respiratory Journal 4

The American College of Rheumatology and EULAR recommend avoiding fluorinated corticosteroids like dexamethasone and betamethasone during breastfeeding, as they are not well metabolized by the placenta and cross more readily into fetal/infant circulation 2, 3

The European Respiratory Journal recommends budesonide and beclomethasone as the preferred inhaled corticosteroids during breastfeeding, due to extensive safety data 4
Fluticasone is classified as "compatible" with breastfeeding, according to the European Respiratory Journal 4

The American College of Rheumatology and the European Respiratory Journal recommend using the lowest effective dose of corticosteroids to maintain disease control, with careful monitoring of maternal and infant health 1, 4
The American College of Rheumatology emphasizes that disease control should be maintained with lactation-compatible medications, as uncontrolled maternal disease poses greater risks than appropriate corticosteroid use 1