Here are some general rules for medications and breastfeeding:

1. Assume that any medication is safe until proved otherwise.  Remember the
risks of not breastfeeding!!  The *conservative* approach is to continue
breastfeeding until the the drug is really shown to have greater risks than
not breastfeeding.

2. A drug which is used for infants can generally be used by breastfeeding
mothers.  Methylprednisolone is frequently given in large doses to infants.

3. A one injection of any drug, even methotrexate (as in to produce
abortion) is a whole different kettle of fish than long term use.  I would
say that methotrexate in this situation is okay.  And methylprednisolone,
even if it weren't in the long term, is as a one injection drug.

4. The discomfort of the mother and baby need to be taken into account.
Here is a drug being given for pain and inflammation, and yet the advice of
the physician may result in the mother having pain and inflammation from
breast engorgement.

5. Doctors and other health professionals who give wrong advice need to get
feedback.  There is no reason the doctor should have told the mother she
needed to wean.  The doctor will continue to tell nursing mothers they have
to stop unless they hear otherwise.

6. The decision about continuing breastfeeding is the decision of the
mother, not the doctor or anyone else.  She needs good information to make
this decision, not scare tactics.

Jack Newman, MD, FRCPC

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