Mommies with experience with breastfeeding and prednisone.

What I have come up with for my little guy with regard to the Asocal. I lowered my med dose to 3200mg instead of 4800mg (not doctor recommend) 3200mg is safe according to Dr. Hale's Medications and Mothers Milk. I will talk to my GI on Monday to see what can be done. I will breastfeed until my dose changes (if it does) then I will mix my breast milk with formula to cut the infant dose in half. In the mean time I found this article that made me feel a lot better because these kids are getting the direct med. The link is below but I cut a paste in the part that was most important to me.

O yeah I scheduled with a kinesilogist. What the heck nothing else is working right?

After researching I feel a lot better about breastfeeding and my meds.

http://www.revolutionhealth.com/conditions/arthritis/juvenile-arthritis/medications/medications?section=section_10


What To Think about

Annual flu shots are recommended for children who are on long-term aspirin therapy. Children on long-term aspirin therapy who get chickenpox or influenza (flu) are at risk for getting Reye's syndrome. Although there is a risk, Reye's syndrome is very rare. Very few cases of Reye's syndrome have been reported in children with chronic arthritis who were being treated with aspirin. If your child has been exposed to chickenpox or flu, talk to the doctor about giving your child acetaminophen to control pain and relieve fever until the incubation period, or the illness itself, has passed.

Combination therapy—using methotrexate with sulfasalazine, hydroxychloroquine, or etanercept—has been used on a limited basis to treat JRA. Most medical experience with combination therapy is with adults; only children with severe JRA that has not improved with methotrexate or sulfasalazine are considered for combination treatment.

It is impossible to predict whether a child will improve with a certain medication. Several different medications may be tried before one is found that controls symptoms and doesn't cause side effects. It can also take weeks to months for a medication to show effect, and symptoms may continue during that time.

Hi MJW, thanks so much for the links. I found the info below on that forum answered by Dr. Hale and he seems to be contradicting things slightly as he states that infants don't typically get Reyes syndrome and the amount of meselemine in mother's milk shouldn't be enough to pose a risk. I am still unsure what I should be doing as I MUST bfed AND take my meds...ugh... I have reduced slightly to 10 pills(down from 12) a day, but am still over his suggested limit. Still causing me some concerns...

Reye's syndrome and its relationship to aspirin is somewhat enigmatic. We do know that aspirin use during a fever, flu, or varicella viral syndrome may dramatically increase the risk of Reye's syndrome. Aspirin is certainly metabolized to salicylic acid, but to be honest with you, we don't know for sure if salicylic acid products (Asacol, Pepto Bismol, etc) are associated with Reye's Syndrome. I ran across a good review of this issue and there still remains some confusion over this relationship (see http://fr.cos.com/cgi-bin/getRec?id=20030417a147).

But to answer your question, exactly, I do not think the use of salicylates during the first three weeks postnatally pose any greater risk of Reye's than at any other time. But if the infant is suffering from a viral infection, then I would be more uncomfortable, even with the salicylcates. Reye's syndrome virtually ALWAYS requires a viral infection at the same time as exposure to aspirin (or perhaps non-acetylated salicylates). If there is no viral infection, then I think the risk of salicylates is minimal.

Interestingly, if you look at the incidence of Reye's syndrome, virtually all of the cases occured in older children (10-15 yrs)...not infants. Perhaps infants are less sensitive.

But to be clear. I do not know with certainty that non-acetylated salicylates will cause Reye's syndrome, so I cannot tell you with certainty that their use early postnatally during an RSV season is safe.

Lastly, I've asked several Reye's experts about the dose-response relationship of Reye's and salicylates, and no one seems to know if these infants have to have a direct and clinical oral dose, or if the miniscule levels in milk would even be a risk factor at all. All the cases thus far reported were from DIRECT administration of acetylsalicylic acid and some possibly from salicylic acid products....none from breast milk containing these drugs.

I'm sorry, but this area is confusing. If anyone out there knows a lot about this area...please phone me...as I've asked many to no avail.

Jen-
I completely agree with Dr. Hale contradicting himself in that post. I thought the same thing. I went to see my GI yesterday and brought up the information and he seemed to not be concerned at all. He's had lots of breastfeeding mommies on meselamine meds. Also, my co-worker who also had UC said that she breastfeed for 1 year on Colazal which is a lot higher dose than asocal and all is well with her daughter. I think that Joma is correct we have to just make our decisions and let it go. If your doctors said its fine and you did all of the research then that is all that you can do. Your a good mommy.

I also took my little guy to Children's yesterday because it seemed that he was not well and they also had absolutely no concerns about my meds when I mentioned them.

After my meeting with my specialist yesterday he suggested the Remicaid before I even had a chance to bring it up. I pray that it works for me. I am at 40 mg of prednisone with little to no improvement. I am also taking the asocal. They gave me the TB test so that I could get started on Remicaid right away. I talked to him about surgery and he was not so keen on that yet. I think he wants to see how I do on the Remicaid. I pray that it gives me some relief.

I am 26 years old and have a 2month old. I have been on Prednisone for autoimmune hepatitis of the liver for years. I tapered down from 20mg to 5mg during my pregnancy and she is fine. Recently I had a flare up and they have asked me to get on 30mg of Prednisone. The doctor and the pediatrician do not know the harm it can cause while breastfeeing and have asked me to stop immediately. I tried and my breasts are so engorged! Cabbage isn't helping. All I can do is read online and it SEEMS that 30mg should be safe to breastfeed. I am scared though because I do not want any developmental or stunt growth in our newborn. Any suggestions or help in the Houston area? These doctors are idiots!

ebmunchkin...

I was on 40mg throughout my pregnancy and nursing...my son is 13 months tomorrow and AWESOME! He's smart, funny, silly, curious...everything a toddler should be and more! I hate to tell you to ignore your doctors...but do. : ) That's silly they asked you to quit nursing cold turkey b/c they didn't know the side effects...don't you think it's their job to do the research? Anyway, you and your little baby will be fine. : ) My high risk doctor, GI and OB all KNEW we would be okay.

schotz217

Welcome. I just had my son, he is now 2 weeks and 2 days old! It took me 5 months to get pregnant with him - basically I got pregnant the first month I was in remission, last April. I think being flared does make it more difficult to get pregnant so it sounds like good news to me that you are going into remission. Are you chartig your cycles? Sounds like you may be.

Anyhow, I was on maintence meselamine (asacol) as well as increased doses in the form of enemas and finally cortifoam when I started to flare in my second tri. I spent a lot of time researching breastfeeding and meds and in the end determined that I was going to go ahead and bf. I spoke with two GI docs, my obgyn, and several pediatricians, many anecdotal stories from other women as well as referring to the Hale research and calling the Motherisk program. All these sources supported my decision although there is not a great deal of research on mesalamine and bfing - Hale is probably the most cautious about bfing and mesalamine. In my mind the benefits of bfing for my baby cant be ignored.

However, by the time Dusty was born I was in solid remission. Generally my pattern is to flare in the fall into the winter and then not again until the following fall so I have decided to see if I can go off my mesalamine for a period of time. I am sure my GI docs would be having a fit if they knew - I suppose I will tell them at some point. Some of the reasons I have made this decision are as follows 1) I have had UC for goig on 10 years so I am pretty clear on my own personal patterns and I am well aware of the small signs and symptoms my body exhibits when it starts to flare 2) I go into my flares slowly so I should have fair warning that I may need to go back on my meds (although this my not hold true when I am not on maintenance meds so I am taking that risk). Anyhow, that being said, this has been my personal choice and it may be too risky for others to do - I may find that it was too risky for me too! Also, based on all my research etc. I know that if I need to go back onto my meds I will try to continue to bf as well.

jo