From the Guidelines
Labetalol, nifedipine, and enalapril are the preferred antihypertensive medications during lactation, as they have established safety profiles with minimal transfer into breast milk and limited effects on the nursing infant. These medications are considered safe due to their low relative infant dose (RID) levels, which are <10% 1.
Key Considerations
- Labetalol, a combined alpha and beta-blocker, is particularly favored due to its low milk concentration and minimal reported adverse effects in infants 1.
- Nifedipine, a calcium channel blocker, also demonstrates acceptable safety with low infant exposure through breast milk 1.
- Enalapril, an ACE inhibitor, may be considered for mothers of healthy, full-term infants, but should be avoided in mothers of premature or renal-impaired infants 1.
Medications to Avoid
- Angiotensin receptor blockers (ARBs) and direct renin inhibitors are not recommended due to insufficient safety data 1.
- Diuretics, such as hydrochlorothiazide and furosemide, may reduce milk production and are generally not preferred in breastfeeding women 1.
Monitoring and Dosing
- When initiating antihypertensive therapy in lactating women, start with the lowest effective dose and monitor both maternal blood pressure control and infant well-being, watching for signs of lethargy, poor feeding, or other unusual symptoms that might indicate medication effects 1.
- The starting and maximum doses for both first-line and alternative agents are outlined in Table 2 of the study by 1, along with lactation safety considerations.
From the FDA Drug Label
Nursing Mothers: 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. The preferred antihypertensive medication during lactation is not explicitly stated in the label, but labetalol is noted to be excreted in small amounts in human milk, with a recommendation to exercise caution when administered to a nursing woman 2.
From the Research
Preferred Antihypertensive Medication During Lactation
The following antihypertensive medications are considered safe for use during lactation:
- Methyldopa: This medication has been shown to have a low milk to plasma (M/P) ratio, indicating that it is safe for use during breastfeeding 3.
- Labetalol: This beta-blocker has been used extensively during pregnancy and lactation, and is considered safe for use during breastfeeding 4, 5, 6.
- Nifedipine: This calcium channel blocker has been shown to have a low M/P ratio, indicating that it is safe for use during breastfeeding 3, 5, 6.
- Amlodipine: This calcium channel blocker has been shown to have minimal excretion in breast milk, making it a safe option for use during lactation 7.
- Enalapril: This ACE inhibitor has been shown to have minimal excretion in breast milk, making it a safe option for use during lactation 7.
Key Considerations
When selecting an antihypertensive medication during lactation, the following factors should be considered:
- The medication's M/P ratio: Medications with low M/P ratios are generally considered safer for use during breastfeeding.
- The medication's safety profile: Medications with a established safety profile during pregnancy and lactation are generally preferred.
- The mother's individual needs: The selection of an antihypertensive medication during lactation should be based on the mother's individual needs and medical history.
Safe Medications
The following medications are considered safe for use during lactation:
Medications to Avoid
The following medications are not recommended for use during lactation:
- Beta-blockers with low protein binding: These medications have been shown to have high M/P ratios, making them less safe for use during breastfeeding 3.
- Diuretics: These medications are not recommended for use during pregnancy and lactation due to the risk of dehydration and electrolyte imbalances 7.
- Renin-angiotensin-aldosterone system inhibitors: These medications are strictly contraindicated during pregnancy and lactation due to the risk of fetal harm 7.