| Drugs |
Suitability
for use in lactation |
Comments |
| Beta
blockers |
Lipid
soluble agents preferred. Lipid solubility governs plasma protein
binding which is the major determinant of drug passage into milk.
Water-soluble agents e.g. atenolol, celiprolol, nadolol, should be
avoided in neonates or when high doses are required.
Monitor infant for signs of beta blockage. |
Acebutolol
|
No
(neonates) |
Hypothermia,
bradycardia and cyanosis reported in a neonate. |
| |
? |
Prefer
alternative |
| Atenolol |
No
(neonates) |
Hypotension,
bradycardia and transient tachypnoea seen in a neonate |
| |
? |
Prefer
alternative |
| Betaxolol
|
Yes |
Low
levels in milk |
| Labetalol |
Yes |
Low levels in milk
Prolonged half life of 24hrs (adult t ½ 2-6hrs) reported in
a premature infant of 37 weeks gestation |
| Metoprolol |
Yes |
Low levels in milk |
| Nadolol |
No
(neonates)
? |
Water-soluble
agent |
| Oxprenolol |
Yes |
Low
levels in milk |
| Propranolol |
Yes |
Low
levels in milk |
| Sotalol |
No |
(neonates)
Water-soluble agent.
Moderate levels in milk |
| Timolol |
Yes |
Low levels in milk |
| Other
beta blockers |
?
|
No
clinical data |
| Thiazides
|
|
Yes
(except high dose) |
Low levels in milk
High doses formerly used to suppress lactation |
| Angiotensin
converting enzyme inhibitors |
Data for the older agents indicates that milk levels are negligible
and unlikely to have a pharmacological effect. Prefer agent for which
clinical data are available |
| |
Captopril
|
Yes |
Low
levels in milk |
| |
Enalapril |
Yes |
Low
levels in milk |
| |
Other
ACE/s |
? |
No
data available |
| Angiotensin-II
receptor antagonists |
LosartanValsartan |
? |
No
data available |
| Calcium
channel blockers |
Data
for the older agents indicates that milk levels are low and unlikely
to have a pharmacological effect. Prefer agent for which clinical
data are available. Exposure to agents with longer half lives e.g
amlodipine, felodipine is best avoided in neonates |
| |
Diltiazem
|
Yes
|
Low
levels in milk |
| |
Nifedipine |
Yes |
Low
levels in milk |
| |
Verapamil |
Yes |
Low
levels in milk |
| |
Other
CCBs |
? |
No
data available |
| Other
antihyper-tensives |
Hydralazine
|
Yes |
Low
levels in milk |
| Methyldopa |
Yes |
Low
levels in milk |
