From the Guidelines
For lactating patients with hypertension, nifedipine and labetalol are considered safe and effective first-line options, with methyldopa also being a viable choice, as indicated by the most recent study 1. When considering antihypertensive medications for lactating patients, it's essential to prioritize the safety and well-being of both the mother and the infant.
- Nifedipine, specifically extended-release formulations, is a suitable option due to its minimal transfer into breast milk and once-daily dosing convenience.
- Labetalol, a combined alpha and beta-blocker, is also a first-line option, although it may require twice-daily dosing.
- Methyldopa has a long history of safety during lactation but may cause sedation in some patients. Key considerations when selecting medication include:
- The mother's blood pressure control needs
- Potential side effects
- Medication timing relative to breastfeeding sessions As stated in the most recent study 1, the goal is to maintain maternal blood pressure control while ensuring infant safety, with regular monitoring of both mother and baby recommended during treatment. It's also important to note that ACE inhibitors like enalapril can be considered for patients requiring these specific agents, as they have demonstrated safety in breastfeeding, according to 1. However, diuretics like hydrochlorothiazide may theoretically reduce milk production in some women, as mentioned in 1 and 1.
From the FDA Drug Label
INDICATIONS AND USAGE Nifedipine extended-release tablets, USP are indicated for the treatment of hypertension. It may be used alone or in combination with other antihypertensive agents. The FDA drug label does not answer the question.
From the Research
Antihypertensive Medications for Lactating Patients
- Methyldopa and nifedipine (Nifedipine LA) are considered safe for use during lactation 2
- Labetalol is also a commonly used antihypertensive medication during pregnancy and lactation 3, 4, 5
- Nifedipine retard, labetalol, and methyldopa are viable initial options for treating severe hypertension in low-resource settings 4
- Amlodipine and enalapril are safe to use during postpartum and breastfeeding, with minimal excretion in breast milk 2
Safety and Efficacy
- Methyldopa, labetalol, and nifedipine-retard are considered safe drugs during pregnancy and lactation 2
- Nifedipine achieved treatment success in most women, similar to hydralazine or labetalol 6
- Less than 2% of women treated with nifedipine experienced hypotension 6
- There were no differences in adverse maternal or fetal outcomes with the use of oral nifedipine, labetalol, or methyldopa 6
Recommendations
- The same therapeutic regimen used during pregnancy can be maintained during postpartum and breastfeeding, trying early withdrawal of methyldopa 2
- Oral nifedipine, and possibly labetalol and methyldopa, are suitable options for treatment of severe hypertension in pregnancy and postpartum 6
- Current guidelines recommend labetalol, nifedipine, and methyldopa as acceptable first-line agents to treat hypertensive disorders of pregnancy in outpatient settings 5