All topical and inhaled corticosteroids can be used while breastfeeding; there is no preferred choice. Recommendations apply to full term, healthy infants only.
All inhaled and topical corticosteroids can be used during breastfeeding. Topical use includes skin, rectal, intranasal, ophthalmic and use in the ear.
Inhaled or topical corticosteroidsare likely to give very small or negligible systemic concentrations in the mother, leading to negligible concentrations in the breast milk, and therefore pose no significant risk to the breastfed infant.
When using corticosteroids in breastfeeding, try to minimise infant exposure by using the lowest effective dose for the shortest effective duration. Use lower potency corticosteroids if appropriate.
Generally, there is no published evidence to support the use of topical or inhaled, corticosteroids during breastfeeding. However, many have been used historically during breastfeeding for years without any reported issues.
They are often used on a short-term basis which further supports their compatibility during breastfeeding.
There is no preferred corticosteroid and all are considered compatible.
Practical tips
Precautions should be taken to avoid direct contact of the breastfeeding infant with treated areas, such as washing hands thoroughly after application and before touching the infant.
If a topical corticosteroid needs to be applied to the breast itself (especially nipples and areola) a mild or moderate potency preparation is preferred. This should be removed with warm water before breastfeeding, and be reapplied after feeding. Creams are preferred to ointments due to ease of removal.
Specific recommendations
Preferred choice
When applied to the skin, used intranasally, or inhaled, beclomethasone can be used during breastfeeding.
Monitoring
No specific infant monitoring is usually required. If topical application of creams and ointments are over large areas for extended periods of time, this may require infant monitoring for adequate feeding, growth and weight gain.
Further information
Beclometasone is considered high potency when applied as a cream or ointment.
Preferred choice
When applied to the skin, or for rectal, intranasal, ophthalmic use, or for use in the ear, betamethasone can be used during breastfeeding.
Monitoring
No specific infant monitoring is usually required. If topical application of creams and ointments are over large areas for extended periods of time, this may require infant monitoring for adequate feeding, growth and weight gain.
Further information
Betamethasone is considered high potency when applied as a cream or ointment.
There are no additional risks when combination products containing antimicrobials or salicylic acid are used.
Preferred choice
Rectal, inhaled or intranasal budesonide can be used during breastfeeding.
Monitoring
No specific infant monitoring is usually required. If rectal use is for extended periods of time, this may require infant monitoring for adequate feeding, growth and weight gain.
Further information
Limited published evidence for using inhaled budesonide during breastfeeding shows negligible amounts are present in breast milk. Inhaled budesonide is also used in infants over 1 month.
Other routes are also considered compatible since the pharmacokinetics suggest negligible levels in breast milk.
Preferred choice
Dexamethasone for ophthalmic use or use in the ear can be used during breastfeeding.
Monitoring
Monitoring is not considered necessary since systemic levels are likely to be negligible.
Further information
There are no additional risks when combination topical preparations containing antibiotics are used.
Preferred choice
When applied to the skin or for ophthalmic use (as an intravitreal implant), fluocinolone can be used during breastfeeding.
Monitoring
Monitoring is not considered necessary since systemic levels will be negligible.
Further information
Fluocinolone acetonide is considered high potency when applied as a cream or ointment.
There are no additional risks when used in combination topical preparations containing antimicrobials.
Preferred choice
When applied to the skin, inhaled or used intranasally, fluticasone can be used during breastfeeding.
Monitoring
No specific infant monitoring is usually required. If topical application of creams and ointments are over large areas for extended periods of time, this may require infant monitoring for adequate feeding, growth and weight gain.
Further information
Fluticasone is considered high potency when applied as a cream or ointment.
There are no additional risks when used in combination in intranasal preparations containing azelastine.
Preferred choice
When applied to the skin, used rectally or for use in the ear, hydrocortisone can be used during breastfeeding.
Monitoring
No specific infant monitoring is usually required. If topical application of creams and ointments are over large areas for extended periods of time, this may require infant monitoring for adequate feeding, growth and weight gain.
Further information
Hydrocortisone is considered low potency when applied as a cream or ointment.
There are no additional risks when combination topical preparations containing antimicrobials or urea are used.
Preferred choice
When applied to the skin, inhaled or used intranasally, mometasone can be used during breastfeeding.
Monitoring
No specific infant monitoring is usually required. If topical application of creams and ointments are over large areas for extended periods of time, this may require infant monitoring for adequate feeding, growth and weight gain.
Further information
Mometasone is considered high potency when applied as a cream or ointment.
Preferred choice
When used rectally, for ophthalmic use, or for use in the ear, prednisolone can be used during breastfeeding.
Monitoring
No specific infant monitoring is usually required. If topical application of creams and ointments are over large areas for extended periods of time, this may require infant monitoring for adequate feeding, growth and weight gain.
Further information
Commonly used in children.
Preferred choice
When applied to the skin, triamcinolone can be used during breastfeeding.
Monitoring
No specific infant monitoring is usually required. If topical application of creams and ointments are over large areas for extended periods of time, this may require infant monitoring for adequate feeding, growth and weight gain.
Further information
Triamcinolone is considered high potency when applied as a cream or ointment.
Topical triamcinolone is only available in combination with chlortetracycline, for which there are no additional risks.
Patient Information
The NHS website provides advice for patients on the use of specific medicines in breastfeeding.
Recommendations are based on published evidence where available. However, evidence is generally very poor and limited, and can require professional interpretation. Assessments are often based on reviewing case reports which can be conflicting and lack detail.
If there is no published clinical evidence, assessments are based on: pharmacodynamic and pharmacokinetic principles, extrapolation from similar drugs, risk assessment of normal clinical use, expert advice, and unpublished data. Simulated data is now increasingly being used due to the ethical difficulties around gathering good quality evidence in this area.