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Exposure of infants to budesonide through breast milk of asthmatic mothersCan we reassure our patients that their breast milk is safe for the baby? Many mothers are required to use drugs during breastfeeding. Almost all drugs transfer into breast milk and this may carry a risk to a breastfed infant. The study published in the October 2007 issue of the Journal of Allergy and Clinical Immunology by Falt, et al, is the first to measure breast milk concentrations of a corticosteroid after inhalation to manage asthma. Asthma has been reported to affect 3.7 to 8.4 percent of pregnant women in the United States (Kwon et al. 2003), making it potentially the most common serious medical problem to complicate pregnancy. The infant having been successfully born, Falt's recent findings give us assurance for encouraging mom to breast feed with confidence (even though breastfeeding does not protect children against developing allergies despite previous hopeful claims) (Mihrshahi et al. 2007). It has previously been shown that patients who received a 50 mg intravenous dose of prednisolone phosphate had an exchange between unbound prednisolone in serum and breast milk that was relatively rapid and bidirectional (Greenberger et al. 1993). An average of 0.025% of the prednisolone dose was recovered in the breast milk and they concluded that prednisolone transfer to breast milk did not appear to pose a clinically significant risk to nursing infants. In this study, maintenance treatment with inhaled budesonide (200 or 400 ?g twice daily) in a small group of asthmatic women resulted in negligible systemic exposure to budesonide in breast-fed infants. The absence of detectable budesonide concentrations in any of the infants' single blood samples support that negligible amounts of budesonide are transferred to infants through breast milk. The estimated daily infant dose of budesonide based on the average breast milk concentration was approximately 0.3% of the daily maternal dose for both 200 and 400 ?g twice daily supporting continuing the practice of maintenance treatment during breast-feeding. |
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