Fludrocortisone is used mainly for mineralocorticoid replacement in adrenocortical insufficiency. The other drugs in this group are used mainly for their anti-inflammatory, glucocorticoid activity, although some have additional mineralocorticoid properties.
There is very limited information on the use of corticosteroids during breastfeeding, although they are likely to be present in milk. Avoid prolonged high dose therapy where possible since adrenal suppression and other adverse effects may occur in the infant. Where such use is unavoidable, monitor the infant’s adrenal function. Short-term use of high dose steroids are normally considered compatible with breastfeeding as the overall exposure will be low.
Maximum doses described as unlikely to cause adverse effects in infant are based on extrapolated anti-inflammatory equivalence to prednisolone, although there is no direct evidence to support this with breastfeeding.
There have been limited reports of corticosteriods reducing milk production; monitor infants for weight gain.