皮膚科 劉權毅醫師

Trace amounts of prednisone and prednisolone have been measured in breast milk (23,24,25 and 26). Following a 10-mg oral dose of prednisone, milk concentrations of prednisone and prednisolone at 2 hours were 26.7 and 1.6 ng/mL, respectively (23). The authors estimated the infant would ingest approximately 28.3 g in 1000 mL of milk. In a second study using radioactive-labeled prednisolone in seven patients, a mean of 0.14% of a 5-mg oral dose was recovered per liter of milk during 4861 hours (24).

In six lactating women, prednisolone doses of 1080 mg/day resulted in milk concentrations ranging from 5% to 25% of maternal serum levels (25). The milk:plasma ratio increased with increasing serum concentrations. For maternal doses of 20 mg once or twice daily, the authors concluded that the nursing infant would be exposed to minimal amounts of steroid. At higher doses, they recommended waiting at least 4 hours after a dose before nursing was performed. However, even at 80 mg/day, the nursing infant would ingest <0.1% of the dose, which corresponds to <10% of the infant's endogenous cortisol production (25).

A 1993 report described the pharmacokinetics of prednisolone in milk (26). Following a 50-mg intravenous dose, an average of 0.025% (range 0.010%0.049%) was recovered from the milk. The data suggested a rapid, bidirectional transfer of unbound prednisolone between the milk and serum (26). The investigators concluded that the measured milk concentrations of the steroid did not pose a clinically significant risk to a nursing infant.

Although nursing infants were not involved in the above studies, it is doubtful whether the amounts measured are clinically significant. The American Academy of Pediatrics considers prednisone to be compatible with breast feeding (27).

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