From the Guidelines
Propranolol can be used during breastfeeding, as it is considered safe with minimal infant exposure and rare adverse effects. The most recent and highest quality study, 1, provides information on the safety of various antihypertensive medications during breastfeeding, including beta-blockers like propranolol. Although propranolol is not explicitly listed in the study, its safety profile is similar to that of labetalol, which is considered safe with a relative infant dose (RID) of 3.6%.
Key Considerations
- The American Academy of Pediatrics classifies propranolol as compatible with breastfeeding, supporting its use in lactating women 2.
- When using propranolol while breastfeeding, it's advisable to monitor the infant for potential side effects such as drowsiness, lethargy, poor feeding, or bradycardia, although these are rare.
- Lower doses of propranolol are preferred when possible to minimize infant exposure.
- The timing of medication intake can also be optimized by taking it immediately after breastfeeding to minimize the concentration in milk during the next feeding.
- Propranolol has a relatively short half-life, which means it doesn't accumulate significantly in breast milk.
- The benefits of treating the mother's condition (such as hypertension, anxiety, or migraine) typically outweigh the minimal risk to the breastfed infant.
Important Notes
- If there are concerns, particularly with premature infants or those with liver or kidney problems, consultation with a pediatrician is recommended.
- The study 3 also mentions that antihypertensive medication is usually continued until BP has normalized, which may be days to several weeks postpartum, and home BP monitoring is suggested.
- It's essential to weigh the benefits of treating the mother's condition against the minimal risk to the breastfed infant and to consider the individual circumstances of each case.
From the FDA Drug Label
Propranolol is excreted in human milk. Caution should be exercised when propranolol hydrochloride extended-release capsules are administered to a nursing woman
- Propranolol use in breastfeeding: Propranolol is excreted in human milk, and caution should be exercised when administered to a nursing woman 4.
- Clinical decision: Due to the presence of propranolol in human milk, it is recommended to exercise caution when using propranolol in breastfeeding women.
- Key consideration: The potential risk to the infant should be weighed against the potential benefit of propranolol therapy for the mother.
From the Research
Propranolol Use in Breastfeeding
- There is limited information available on the use of propranolol in breastfeeding mothers, as most studies focus on its therapeutic effects in various medical conditions 5, 6, 7, 8, 9.
- One study describes two cases of breastfed infants whose mothers were taking multiple antihypertensives and were initiated on propranolol for infantile hemangiomas treatment, discussing the theoretical risk of propranolol use in this setting 5.
- However, there is no direct evidence on the safety and efficacy of propranolol in breastfeeding mothers, and its use in this context is not well-studied.
- Propranolol is a noncardioselective β-blocker with various therapeutic uses, including hypertension, arrhythmias, and anxiety disorders 6, 8.
- The lack of specific guidance on propranolol use in breastfeeding mothers suggests that caution should be exercised, and healthcare professionals should carefully evaluate the potential risks and benefits before recommending its use in this population.