Anti-hypertensive therapy with propranolol during pregnancy and lactation

Abstract

Summary A hypertensive women was treated throughout pregnancy with propranolol 40 mg daily without complication. At delivery the umbilical cord plasma concentration was similar to that in the maternal venous plasma. Milk:plasma ratios were less than 1, although a higher ratio would be predicted. Estimated daily intake of propranolol in breast milk by the infant was about 3 micrograms. There appears to be no reason to advise women receiving propranolol to avoid breast feeding.

Excretion of Antihypertensive Medication Into Human Breast Milk: A Systematic Review

“…The time of sampling post dosage also varied. In all but three studies (24,36,41), the plasma and milk samples were matched for time of sampling.…”

Maternal Medication, Drug Use, and Breastfeeding

“…The b-blockers of choice are metoprolol (RID 1.4%) and propranolol (RID 0.3%), neither of which has been associated with any infant adverse events. 46,47 In addition, labetalol has not been associated with any adverse effects in infants and has a low RID of 0.6%. 48 Although rarely, atenolol and acebutolol have both been associated with infant adverse effects such as cyanosis, tachypnea, bradycardia, hypotension, and low body temperature, and are not preferred agents.…”

Beta Blockers and Lactation: An Update

“…The mean blood-milk ratio 2 hours after dos ing was found to be 2.0. Case reports by Tay lor and Turner 18 and Levitan and Manion 19 involv ing doses rang ing from 30 to 40 mg daily also dem on strated milk lev els to be lower than those found in plasma. In both cases, the infant was devoid of any adrenergic symp toms, and the amount of drug to which the infant was exposed was found to be neg li gi ble.…”