Betamethasone

Corticosteroid with high anti-inflammatory potency (25 times more than hydrocortisone) with the main glucocorticoid effect and almost no mineralcorticoid effect. Oral, parenteral (iv, im, intra-articular, intra-lesional), topical (dermatological, otic and ophthalmological) and inhalation administration. Authorized use in children under one year.

Since the last update we have not found any published data on its excretion in breast milk.

Its pharmacokinetic data make it likely to pass into breast milk in an amount that could be significant, so in prolonged treatments it is advisable to use corticosteroids known for their scarce passage into milk.

SYSTEMIC USE: ORAL, IM, IV, INTRA-ARTICULAR, INTRALESIONAL

When administered before delivery it may induce delay in phase II of Lactogenesis (coming-in) and a decrease of milk production within the first week post-partum ^{(Henderson 2008)}. Other corticosteroids such as dexamethasone can cause a decrease in prolactin, which could decrease milk production especially during the first weeks ^{(Hubina 2002, Risch 1987)}. Large intra-articular doses of other corticosteroids (methylprednisolone, triamcinolone) may transitory decrease milk production. ^{(Babwah 2013, McGuire 2012).} Lower dose depot injection of betamethasone into the shoulder joint did not noticeably reduce milk production.^{(McGuire 2012)}

Corticosteroids are commonly used in Pediatrics and have no side effects when used alone or in short treatments.

In nursing mothers, the occasional use and in non-prolonged treatments of betamethasone is compatible with breastfeeding by monitoring milk production.

TOPICAL USE: DERMATOLOGICAL, OTOLOGICAL, OPHTHALMOLOGICAL, INHALED

The small dose and poor plasma absorption of most topical preparations (nasal, ophthalmological, otological, dermatological ^{(Leo 2011)} or inhaled) make it very unlikely that a significant amount will pass into breast milk.

Whenever a treatment for nipple eczema or dermatitis is required the lowest potency steroid compound should be used ^{(Barrett 2013)}. It should be applied right after the feed to make sure it has disappeared before the next nursing occurs. Otherwise, wipe cream out with a clean gauze. Do not continuously use for longer than ten days at a time. ^{(Amir 1993)}

Preparations containing betamethasone, mupirocin and miconazole are not superior to lanolin creams in treating nipple pain, cracking and inflammation than lanolin creams. ^{(Dennis 2012)}

Reportedly, a case of mineral-steroid toxicity has occurred due to continuous use of cream on the nipple. ^{(De Stefano 1983)}

It is advisable to avoid the application to the nipple of creams, gels and other topical products containing paraffin (mineral oil) so that the infant does not absorb them. ^{(Concin 2008, Noti 2003)}

WHO Model List of Essential Drugs 2002: Topical use compatible with breastfeeding. ^{(WHO 2002)}