Last update July 22, 2022

Fluticasone

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

It is a potent glucocorticoid used inhaled for asthma, nasally for rhinitis and polyps and applied topically on various skin disorders.

At latest update no relevant data on this subject were found in connection with breastfeeding.

Its pharmacokinetic characteristics (low systemic absorption, moderately elevated molecular weight, high plasma protein binding and large volume of distribution), make it highly unlikely that significant quantities will pass into breast milk. (Chambers 2021)

Its low oral bioavailability protects the infant from intestinal absorption.

Directly administered in childhood, only prolonged treatment with high doses of fluticasone can affect pituitary-adrenal function and growth. (Allen 2020, Todd 2002 & 1996)

Another similar inhaled corticosteroid (Budesonide) is excreted in breast milk in negligible amounts.

Several medical societies and expert authors consider topical, systemic or inhaled steroid medication to be safe or probably compatible with breastfeeding. (Hale, LactMed, Middleton 2020, Briggs 2015, Schaefer 2015, Amir 2011, National Asthma 2004, Ellsworth 1994)

TOPICAL USE:

Whenever a treatment for nipple eczema or dermatitis is required, the lowest potency steroid compound should be used. It should be applied right after the feed to make sure it has disappeared before the next nursing. Otherwise, wipe cream out with a clean gauze. Do not continuously use for longer than a week. Reportedly, a case of mineral-steroid toxicity has occurred due to continuous use of cream on the nipple. (De Stefano 1983)

Creams, gels or similar products that contain paraffin or mineral oil should not be used on the nipple to avoid absorption by the infant.(Concin 2008, Noti 2003)

Alternatives

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Fluticasone is also known as


Fluticasone in other languages or writings:

Tradenames

Main tradenames from several countries containing Fluticasone in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. oral: 1; inhal: 6 -18 %
Molecular weight 500 daltons
Protein Binding > 99 %
VD 4.2 - 8.6 l/Kg
pKa 12.19 -
Tmax 0.25 - 1 hours
7.8 - 15.1 hours

References

  1. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on March 17, 2022 Full text (link to original source)
  2. LactMed. Drugs and Lactation Database (LactMed). Internet. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/ 2006 - Consulted on March 15, 2022 Full text (link to original source)
  3. Chambers CD, Krishnan JA, Alba L, Albano JD, Bryant AS, Carver M, Cohen LS, Gorodetsky E, Hernandez-Diaz S, Honein MA, Jones BL, Murray RK, Namazy JA, Sahin L, Spong CY, Vasisht KP, Watt K, Wurst KE, Yao L, Schatz M. The safety of asthma medications during pregnancy and lactation: Clinical management and research priorities. J Allergy Clin Immunol. 2021 Jun;147(6):2009-2020. Abstract Full text (link to original source)
  4. Allen DB. Inhaled Corticosteroids and Endocrine Effects in Childhood. Endocrinol Metab Clin North Am. 2020 Dec;49(4):651-665. Abstract
  5. Middleton PG, Gade EJ, Aguilera C, MacKillop L, Button BM, Coleman C, Johnson B, Albrechtsen C, Edenborough F, Rigau D, Gibson PG, Backer V. ERS/TSANZ Task Force Statement on the management of reproduction and pregnancy in women with airways diseases. Eur Respir J. 2020 Feb 6;55(2). pii: 1901208. Abstract Full text (link to original source) Full text (in our servers)
  6. Schaefer C, Peters P, Miller RK. Drugs During Pregnancy and Lactation. Treatment options and risk assessment. Elsevier, Third Edition. 2015
  7. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. Tenth edition (acces on line) 2015
  8. Amir LH, Pirotta MV, Raval M. Breastfeeding--evidence based guidelines for the use of medicines. Aust Fam Physician. 2011 Sep;40(9):684-90. Review. Abstract Full text (link to original source) Full text (in our servers)
  9. Concin N, Hofstetter G, Plattner B, Tomovski C, Fiselier K, Gerritzen K, Fessler S, Windbichler G, Zeimet A, Ulmer H, Siegl H, Rieger K, Concin H, Grob K. Mineral oil paraffins in human body fat and milk. Food Chem Toxicol. 2008 Abstract
  10. National Asthma Education and Prevention Program Asthma and Pregnancy Working Group. Managing asthma during pregnancy: recommendations for pharmacologic treatment-2004 update. 2004;1-57. None 2004 Full text (link to original source) Full text (in our servers)
  11. Noti A, Grob K, Biedermann M, Deiss U, Brüschweiler BJ. Exposure of babies to C15-C45 mineral paraffins from human milk and breast salves. Regul Toxicol Pharmacol. 2003 Abstract
  12. Todd GR, Acerini CL, Ross-Russell R, Zahra S, Warner JT, McCance D. Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom. Arch Dis Child. 2002 Dec;87(6):457-61. Abstract Full text (link to original source)
  13. Todd G, Dunlop K, McNaboe J, Ryan MF, Carson D, Shields MD. Growth and adrenal suppression in asthmatic children treated with high-dose fluticasone propionate. Lancet. 1996 Jul 6;348(9019):27-9. Abstract
  14. Ellsworth A. Pharmacotherapy of asthma while breastfeeding. J Hum Lact. 1994 Abstract
  15. De Stefano P, Bongo IG, Borgna-Pignatti C, Severi F. Factitious hypertension with mineralocorticoid excess in an infant. Helv Paediatr Acta. 1983 Abstract

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