Can metoprolol be prescribed to a breastfeeding mother?

Metoprolol Can Be Prescribed to Breastfeeding Mothers

Yes, metoprolol can be safely prescribed to breastfeeding patients and is specifically recommended as the preferred beta-blocker for lactating women with hypertension or heart failure. 1

Guideline-Based Recommendations

The European Society of Cardiology and American College of Cardiology both recommend metoprolol as the preferred beta-blocker during lactation for both hypertension and heart failure management in the postpartum period. 1 This represents the highest level of guideline support for metoprolol use while breastfeeding.

Why Metoprolol is Preferred Among Beta-Blockers

• Metoprolol is specifically chosen over other beta-blockers like atenolol, which should be avoided during lactation due to higher concentration in breast milk and greater risk to the infant. 1
• Beta-1 selective agents like metoprolol are recommended over non-selective beta-blockers during lactation for cardiovascular conditions. 1
• The European Society of Cardiology lists metoprolol as compatible with breastfeeding, along with other beta-blockers that have high protein binding. 2, 3

Safety Profile and Infant Exposure

The FDA drug label confirms that metoprolol is excreted in breast milk in very small quantities - an infant consuming 1 liter of breast milk daily would receive less than 1 mg of the drug. 4 This minimal exposure supports the safety profile established in guidelines.

• Research confirms metoprolol safety during breastfeeding, with studies showing that while breast milk concentration is three times higher than maternal plasma, suckling newborns show very low or unmeasurable plasma levels between feedings. 5, 6
• Metoprolol is classified as safe during breastfeeding in multiple authoritative reviews of anti-migraine and cardiovascular drugs. 5

Required Monitoring

Newborns should be supervised for 24-48 hours after delivery to exclude hypoglycemia, bradycardia, and respiratory depression if the mother was taking metoprolol during pregnancy. 1

Ongoing monitoring of breastfed infants should focus on:

• Heart rate changes 1
• Weight gain patterns 1
• Signs of beta-blocker effects (lethargy, poor feeding) 1

Clinical Decision Algorithm

1. For hypertension in breastfeeding mothers: While nifedipine is preferred as first-line therapy 2, metoprolol remains an appropriate and safe option if a beta-blocker is specifically indicated. 1, 3

2. For heart failure in lactating women: Continue or initiate metoprolol as part of guideline-directed medical therapy - do not discontinue necessary beta-blocker therapy solely due to breastfeeding. 1

3. If beta-blocker is required: Choose metoprolol over atenolol or nadolol due to superior safety profile in lactation. 1, 5

Important Caveats

• Do not avoid metoprolol simply because of breastfeeding - the benefits of treating maternal cardiovascular disease outweigh the minimal infant exposure risk. 1
• Monitor neonatal heart rate as the primary safety parameter when prescribing metoprolol to breastfeeding mothers. 1
• Consider timing of doses - although metoprolol levels in infant plasma remain very low between feedings, administering medication immediately after breastfeeding minimizes theoretical peak exposure. 6, 7