From the Guidelines
Labetalol is the recommended antihypertensive medication for a lactating woman, due to its minimal transfer into breast milk and established safety profile, as supported by the most recent study 1.
Key Considerations
- The choice of antihypertensive medication for a lactating woman should prioritize the safety of the infant, with minimal transfer into breast milk and no reported adverse effects.
- Labetalol, methyldopa, and nifedipine are generally considered safe first-line antihypertensive medications for lactating women, as stated in 1 and 1.
- ACE inhibitors like enalapril may be considered in some cases, but newer agents in this class have limited safety data, as noted in 1.
Medication Options
- Labetalol: starting at 100-200 mg twice daily, with a relative infant dose (RID) of 3.6% 1.
- Methyldopa: 250-500 mg twice daily, with a long history of use during lactation and no reported adverse effects in breastfed infants.
- Nifedipine: extended-release, 30-60 mg daily, with a RID of 2.3%-3.4% 1.
Important Notes
- The choice of medication should be individualized based on the mother's blood pressure control needs, comorbidities, and previous medication response.
- Diuretics like hydrochlorothiazide are usually not first-line as they may decrease milk production, as mentioned in 1.
- Beta-blockers such as propranolol and metoprolol are generally acceptable, though high doses should be avoided, as stated in 1 and 1.
From the FDA Drug Label
Methyldopa appears in breast milk. Therefore, caution should be exercised when methyldopa is given to a nursing woman. 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.
Antihypertensive for lactating lady:
- Methyldopa and labetalol can be used with caution in lactating women, as they appear in breast milk.
- However, labetalol is preferred due to the smaller amount excreted in human milk (approximately 0.004% of the maternal dose) compared to methyldopa.
- It is essential to weigh the benefits and risks of using these medications in lactating women and to monitor the infant for any potential adverse effects 2, 3.
From the Research
Antihypertensive Medications for Lactating Women
- The choice of antihypertensive medication for a lactating woman is crucial to ensure the safety of both the mother and the baby.
- According to 4, the same therapeutic regimen used during pregnancy can be maintained during breastfeeding, with the exception of methyldopa, which can be withdrawn early.
- Safe antihypertensive medications during lactation include:
- Methyldopa
- Labetalol
- Nifedipine
- Amlodipine (with a lower level of evidence of safety)
- Medications that are contraindicated or not recommended during lactation include:
- Diuretics
- Atenolol and other beta-blockers
- Renin-angiotensin-aldosterone system inhibitors
- As stated in 5, the management of increased blood pressure in the postpartum period and agents to use in lactation should be carefully considered.
- Additionally, 6 reviews the pharmacology of commonly used antihypertensive medications during pregnancy and their effects on lactation.
- A systematic review and meta-analysis 7 found that several drugs can be used to treat severe hypertension in pregnancy, including oral/sublingual nifedipine, IV/oral labetalol, and oral methyldopa, which may also be suitable for lactating women.