Triamcinolone (systemic, intra-articular, intramammary and ophthalmic)

Corticosteroid with main glucocorticoid action and anti-inflammatory effect of similar potency to prednisolone. Systemic (oral, injectable), inhaled (bronchial, nasal), intra-articular, intravitreal, intramammary and topical dermal administration. Indicated in the treatment of rheumatic and collagen diseases, inflammatory bowel disease, granulomatous mastitis, dermatitis, asthma, rhinitis, etc.

This commentary is about systemic, intra-articular, intramammary and ophthalmic Triamcinolone; for inhaled or topical dermatological use, see Inhaled Triamcinolone, Topical Triamcinolone.

At the time of last update, we found no published data on the excretion in breast milk of injected, intra-articular or ophthalmic triamcinolone.

After intramammammary injection of triamcinolone to treat granulomatous mastitis, triamcinolone levels in the milk of the affected breast were undetectable ^{(Rosen 2023)} or extremely low: relative infant dose 0.23% ^{(Mitchell 2024)}, the authors considering that it is not necessary to withdraw lactation or wait any time to breastfeed in case of intramammammary injection of triamcinolone. In one mother, milk production decreased in the diseased breast, but not in the unaffected breast, recovering after 15 days. ^{(Rosen 2023)}

Intra-articular Triamcinolone administration at the wrist ^{(Smuin 2016)} or epidural in cervical area ^{(McGuire 2012)} caused temporary decrease in milk production of one to four weeks duration that resolved in both cases with maintenance and stimulation of lactation and use of galactogogues (domperidone, fenugreek).

Although after both intraocular ^{(Shen 2010, Degenring 2004)} and epidural ^{(Hooten 2016)} administration of triamcinolone, the elimination half-life is about 22 - 25 days, plasma levels are undetectable or very low, not clinically significant. The maximum peak concentration after these types of administration occurs at 24 hours. ^{(Hooten 2016, Shen 2010, Degenring 2004)}

There is consensus among experts that, in general, neither systemic corticosteroids ^{(National Asthma Education 2004)}, nor inhaled corticosteroids ^{(Middleton 2020, National Asthma Education 2004)} pose a contraindication to breastfeeding.

The low plasma levels obtained after ophthalmic administration suggest a very low risk during lactation.

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

Until more data are published on this drug in relation to lactation, alternatives with a known pharmacokinetic profile that is safer for lactation (greater protein binding, shorter half-life and lower oral bioavailability) may be preferable, especially during the neonatal period and in case of prematurity.

If used during lactation, milk production should be monitored.

Translated with DeepL.com (free version)

See below the information of these related products:

• Triamcinolone (topical use) (Safe substance and/or breastfeeding is the best option.)
• Triamcinolone Inhaled (Safe substance and/or breastfeeding is the best option.)