From the Guidelines
Labetalol, nifedipine, and enalapril are considered safe for breastfeeding mothers, with labetalol being a first-line option due to its efficacy and low risk of adverse effects on the infant 1. When selecting an antihypertensive medication for a breastfeeding mother, it is essential to consider the mother's previous response to antihypertensives, comorbidities, and potential side effects.
- Labetalol (100-400 mg twice daily) is a suitable option, with a relative infant dose (RID) of 3.6% 1.
- Nifedipine extended-release (30-90 mg daily) is also a viable option, with an RID of 2.3%-3.4% 1.
- Enalapril (5-40 mg daily) is another safe option, with an RID of 1.1% 1. It is crucial to monitor the mother's blood pressure and assess the infant's well-being while using these medications.
- Mothers should take their medication immediately after breastfeeding to minimize infant exposure.
- Regular monitoring of the infant's growth and development is also necessary to ensure that the medication is not affecting the infant's health. The choice of medication should be based on the individual patient's needs and medical history, with consideration given to the potential risks and benefits of each medication.
- In general, medications with a low RID and a established safety profile during breastfeeding should be preferred.
- It is also essential to educate the mother on the importance of monitoring her blood pressure and seeking medical attention if she experiences any adverse effects or concerns.
From the FDA Drug Label
Small amounts of labetalol (approximately 0. 004% of the maternal dose) are excreted in human milk. Caution should be exercised when TRANDATE Tablets are administered to a nursing woman. Methyldopa appears in breast milk. Therefore, caution should be exercised when methyldopa is given to a nursing woman.
- Labetalol and methyldopa are both excreted in human milk, but the amount of labetalol is relatively small (approximately 0.004% of the maternal dose).
- Caution should be exercised when administering either of these medications to a nursing woman.
- There is no clear indication that these medications are absolutely contraindicated in breastfeeding women, but careful consideration should be given to the potential risks and benefits 2, 3.
From the Research
Anti-Hypertensive Medications for Breastfeeding
- The following anti-hypertensive medications are considered safe for use during breastfeeding:
- These medications have low excretion rates in breast milk, making them suitable options for breastfeeding mothers with hypertension 4, 5
- It is essential to note that the safety of these medications during breastfeeding may depend on various factors, including the dosage and individual patient characteristics 5
- Renin-angiotensin-aldosterone system inhibitors are strictly contraindicated during pregnancy but may be safe during breastfeeding, although more research is needed to confirm this 4, 5
- Diuretics, atenolol, and other beta-blockers are not recommended for antihypertensive purposes during pregnancy and breastfeeding due to limited safety data 4