Triamcinolone use while Breastfeeding

Summary of Use during Lactation

Because no information is available on the use of oral triamcinolone during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. 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. Expert opinion considers inhaled and oral corticosteroids acceptable to use during breastfeeding.[1,2] Local injections, such as for tendinitis, would not be expected to cause any adverse effects in breastfed infants. Single injections of triamcinolone acetonide into the breast for treating granulomatous mastitis appear to be acceptable. Medium to large doses of corticosteroids given systemically or injected into joints or the breast have been reported to cause temporary reduction of lactation. See also Triamcinolone, Topical.

Drug Levels

Maternal Levels. A woman with idiopathic granulomatous mastitis received an injection of 40 mg of triamcinolone acetonide into erythematous areas of the affected breast. She pumped milk samples 1 and 4 hours after the injection, then daily at the same time of day for 1 week. No triamcinolone acetonide was detected (<0.78 mcg/L) in any of the collected samples.[3]

A woman with granulomatous mastitis was given an injection of 120 mg of triamcinolone acetonide mixed with 6 mL of 2% lidocaine into the affected area of left breast. Milk samples were taken at 0, 14, 73, and 169 hours after the injection. The highest concentration of 24.9 mcg/L of triamcinolone acetonide occurred at 14 hours after the dose. The drug concentration fell to 2.1 mcg/L at 73 hours and was below the detection limit of 0.78 mcg/L at 169 hours. At the worst-case milk concentration, the relative infant dose would be only 0.23% of the maternal weight-adjusted dosage.[4]

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

None reported with any corticosteroid.

Effects on Lactation and Breastmilk

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.[5] The decrease in the mother's milk supply was possibly caused by the corticosteroid injections. Medium to large doses of corticosteroids given systemically or injected into joints or the breast have been reported to cause temporary reduction of lactation.[3,5-8]

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.[9] 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.[10] 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.[7]

A woman with idiopathic granulomatous mastitis received an injection of 40 mg of triamcinolone acetonide into erythematous areas of the affected breast. Her milk production decreased from the injected left breast. She had originally been able to express 60 mL on that side with an electric breast pump, and after the injection she was only able to express 10 mL. Her milk supply on the affected side recovered over the course of 2 weeks. Production on the unaffected right breast did not decrease.[3]

Alternate Drugs to Consider

(Systemic) Methylprednisolone, Prednisolone, Prednisone

References

1.

National Heart, Lung, and Blood, Institute, National Asthma, Education, and, Prevention, Program, Asthma, and, Pregnancy, Working, Group. NAEPP expert panel report. Managing asthma during pregnancy: recommendations for pharmacologic treatment-2004 update. J Allergy Clin Immunol 2005;115:34-46. [PubMed: 15637545]

2.

Middleton PG, Gade EJ, Aguilera C, et al. ERS/TSANZ Task Force Statement on the management of reproduction and pregnancy in women with airways diseases. Eur Respir J 2020;55:1901208. [PubMed: 31699837]

3.

Rosen-Carole C, Datta P, Palmiter K, et al. Transfer of injected triamcinolone into human milk of a lactating patient suffering from idiopathic granulomatous mastitis. Breastfeed Med 2023;18:74-7. [PubMed: 36638194]

4.

Mitchell K, Krutsch K, Datta P, Hale TW. Evaluating the transfer of injected triamcinolone acetonide into human milk: Confirmatory results. Breastfeed Med 2024;19:309-10. [PubMed: 38502820]

5.

McGuire E. Sudden loss of milk supply following high-dose triamcinolone (Kenacort) injection. Breastfeed Rev 2012;20:32-4. [PubMed: 22724311]

6.

Babwah TJ, Nunes P, Maharaj RG. An unexpected temporary suppression of lactation after a local corticosteroid injection for tenosynovitis. Eur J Gen Pract 2013;19:248-50. [PubMed: 24261425]

7.

Smuin DM, Seidenberg PH, Sirlin EA, et al. Rare adverse events associated with corticosteroid injections: A case series and literature review. Curr Sports Med Rep 2016;15:171-6. [PubMed: 27172081]

8.

Das N, Dave S, Dangaich R, et al. Lactation failure following therapeutic steroid treatment in a mother with postpartum depression and spinal-dural arteriovenous fistula: Case report and literature review. Int J Gynaecol Obstet 2024;165:389-91. [PubMed: 38093554]

9.

Henderson JJ, Hartmann PE, Newnham JP, Simmer K. Effect of preterm birth and antenatal corticosteroid treatment on lactogenesis II in women. Pediatrics 2008;121:e92-100. [PubMed: 18166549]

10.

Henderson JJ, Newnham JP, Simmer K, Hartmann PE. Effects of antenatal corticosteroids on urinary markers of the initiation of lactation in pregnant women. Breastfeed Med 2009;4:201-6. [PubMed: 19772378]

Substance Name

Triamcinolone

CAS Registry Number

124-94-7

Drug Class

Breast Feeding

Lactation

Milk, Human

Corticosteroids, Systemic

Glucocorticoids

Anti-Inflammatory Agents