Can I take hydrocortisone tablets while pregnant or breastfeeding?

If pregnant or breast-feeding ask a health professional before use.

Drug Facts label: Marie Originals Medicated Outdoor Anti Itch (topical), Marie's Original Formulas, LLC. Label on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.

8.1 Pregnancy Risk Summary Untreated adrenocortical insufficiency in pregnancy can result in a high rate of complications, including maternal mortality. The use of physiologic doses of hydrocortisone is not expected to cause major birth defects, miscarriage and adverse maternal and fetal outcomes. Available data from observational studies with hydrocortisone use in pregnancy have not identified a clear drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes (see Data ). The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2–4% and 15–20%, respectively.

Prescribing label, section “8.1 Pregnancy” (opening excerpt): Alkindi Sprinkle (oral), Eton Pharmaceuticals, Inc. Read the full section on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.

Hydrocortisone (cortisol) is a normal component of breastmilk, but it has not been studied in milk after exogenous administration in pharmacologic amounts. Although it is unlikely that dangerous amounts of hydrocortisone would reach the infant, a better studied corticosteroid might be preferred. Maternal use of hydrocortisone as an enema would not be expected to cause any adverse effects in breastfed infants. Local maternal injections, such as for tendinitis, would not be expected to cause any adverse effects in breastfed infants. 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 Hydrocortisone, Topical.

Cortisol in breastmilk might have a role in intestinal maturation, the intestinal microbiome, growth, body composition or neurodevelopment, but adequate studies are lacking.[1] Concentrations follow a diurnal rhythm, with the highest concentrations in the morning at about 7:00 am and the lowest concentrations in the late afternoon and evening.[2,3] Cortisol concentration in milk increases with infant age and milk cortisol levels; it decreases with complementary feeding and infant illness.[4,5] Cortisol in milk may protect against later infant obesity, especially in girls;[6] however, in another study, milk glucocorticoid levels were positively associated with percent fat mass, adiposity and head circumference at 1 year of age.[7] Maternal stress can increase breastmilk cortisol levels, especially with preterm births.[8-11] Milk cortisol may mediate infant emotions and infant sleep, but not crying, is correlated with the levels of cortisone and cortisol in milk.[12,13] Some information indicates that maternal adverse childhood experiences may decrease cortisol concentration in their breastmilk.[14]

“Summary of Use during Lactation”, LactMed record “Hydrocortisone” (LM138), quoted verbatim. Everything LactMed reports about Hydrocortisone while breastfeeding.

8.2 Lactation Risk Summary Cortisol is present in human milk. The use of hydrocortisone at a physiologic dose for adrenocortical insufficiency is not expected to adversely affect the breastfed infant or milk production. There are no data on the presence of hydrocortisone in breast milk, the effect on the breastfed infant or on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for ALKINDI SPRINKLE and any potential adverse effects on the breastfed infant from ALKINDI SPRINKLE or from the underlying maternal condition.

Prescribing label, section “8.2 Lactation”: Alkindi Sprinkle (oral), Eton Pharmaceuticals, Inc. Label on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.