Safe Blood Pressure Medications for Breastfeeding Mothers: What You Need to Know

Antihypertensive medication

Due to having hypertension, I have been taking long-acting NORVASC and CONCOR for control.
Later, upon becoming pregnant and following my doctor's advice, I switched to the shorter-acting ADALET to manage my blood pressure, as it is less likely to affect the fetus.
I would like to know if, after giving birth, I can switch back to long-acting blood pressure medications while breastfeeding, or if there are concerns about the medication being secreted into breast milk and affecting the infant.
What safe and suitable medications for breastfeeding would you recommend? Thank you!

MARY, 20~29 year old female. Ask Date: 2009/05/21

Dr. Xie Weigong reply Pharmacology

Hello Mary,
Norvasc is a calcium channel blocker that inhibits the influx of calcium ions into the heart and smooth muscle, and it is a derivative of Dihydropyridine.
This medication has a relaxing effect on vascular smooth muscle, leading to vasodilation and improved blood flow, thereby achieving the goal of lowering blood pressure.
Common side effects of this medication include fatigue, nausea, facial flushing, dizziness, headache, constipation, and edema.
If symptoms are severe, it is important to notify a physician.
The safety of this medication for use in pregnant and breastfeeding women has not been established; however, high doses in pregnant women may prolong gestation and potentially cause fetal growth defects.
Therefore, unless carefully evaluated by a physician, this medication is not recommended for pregnant women.
Concor is a potent and highly selective β-receptor blocker that reduces heart rate and inhibits renin.
By decreasing cardiac activity, it lowers the myocardial oxygen demand.
It is indicated for patients with angina and hypertension.
Use during pregnancy and breastfeeding is contraindicated.
This medication can enhance the effects of other antihypertensive agents.
When used in conjunction with calcium channel blockers or other antiarrhythmic medications, patients should be closely monitored for hypotension or arrhythmias.
During treatment with this medication, it is advisable to avoid the injection of calcium channel blockers and antiarrhythmic drugs.
For potential bradycardia, hypotension, and hypoglycemia in newborns, this medication should ideally be discontinued 72 hours prior to delivery.
If this is not feasible, careful monitoring should be conducted within 40-72 hours after the newborn's birth.
Generally, treatment with this medication is considered long-term; do not change the dosage arbitrarily without physician guidance, and do not abruptly discontinue use; dosage should be gradually reduced.
Nifedipine (Adalat, 10mg) is sometimes used by clinicians for the management of hypertension in pregnant women.
Therefore, if hypertension is not well-controlled and long-term medication is required, breastfeeding is not recommended.
Wishing you good health,
Pharmacist Hsieh Wei-Kung
May 22, 2009

Reply Date: 2009/05/21

More Info

When it comes to managing high blood pressure in breastfeeding mothers, it's crucial to consider both the effectiveness of the medication and its safety for the infant. Many mothers are understandably concerned about the potential effects of antihypertensive medications on their breastfed babies. Here’s a comprehensive overview of what you need to know regarding safe blood pressure medications during breastfeeding.

Understanding Blood Pressure Medications
1. Types of Medications: Common classes of antihypertensive medications include diuretics, ACE inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers, and beta-blockers. Each class has different implications for breastfeeding.

2. Safety Profiles:
- Calcium Channel Blockers: Medications like Amlodipine (Norvasc) and Nifedipine (Adalat) are generally considered safe during breastfeeding. Amlodipine has minimal transfer into breast milk and is often recommended for nursing mothers.

- Beta-Blockers: Concor (Bisoprolol) is another option that is deemed safe for breastfeeding. It has low levels in breast milk and is well-tolerated by infants.

- ACE Inhibitors and ARBs: Medications like Lisinopril and Losartan are also considered safe, but it's essential to monitor the infant for any potential side effects, as these medications can pass into breast milk.

3. Short-acting vs. Long-acting: While short-acting medications like Adalat may be preferred during pregnancy due to their lower risk of affecting fetal development, long-acting medications can often be safely resumed postpartum. The key is to ensure that the medication does not adversely affect the infant.

Recommendations for Breastfeeding Mothers
1. Consult Your Healthcare Provider: Before making any changes to your medication regimen, it’s vital to discuss your concerns with your healthcare provider. They can provide personalized advice based on your medical history and the specific medications you are using.

2. Monitor Your Baby: If you switch back to a long-acting medication like Norvasc or Concor, keep an eye on your baby for any unusual symptoms, such as lethargy, feeding difficulties, or changes in behavior. Most infants tolerate these medications well, but vigilance is essential.

3. Timing of Doses: If you are concerned about the medication passing into breast milk, consider timing your doses around breastfeeding. For example, taking your medication right after a feeding may help minimize the amount present in your milk during the next feeding.

4. Alternative Medications: If you find that your current medications are causing side effects or if you have concerns about their safety, ask your doctor about alternatives that are known to be safe during breastfeeding.

5. Hydration and Lifestyle: In addition to medication, maintaining a healthy lifestyle can help manage blood pressure. Staying hydrated, eating a balanced diet, and engaging in moderate physical activity (as advised by your healthcare provider) can contribute positively to your overall health.

Conclusion
In summary, many blood pressure medications are safe for breastfeeding mothers, including long-acting options like Norvasc and Concor. The most important step is to maintain open communication with your healthcare provider to ensure that both your health and your baby's well-being are prioritized. By carefully managing your blood pressure and monitoring your infant, you can successfully navigate the challenges of postpartum life while breastfeeding.

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