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HypertensioninPregnancyNCBIBookshelf

Drugclass/name M:Pratio Relative Reportedpaediatric Monitoring Comments Other

infant concerns
dose
Thiazidediuretics
Bendroflumethiazide, Amounttoosmall
tobeharmful199
Largedosesmay
suppress
lactation197199202
Americanacademy
ofpaediatrics
classifiesas
compatiblewith
breastfeeding202
Chlortalidone 0.062 15.5%198 Nil198 Amounttoosmall
tobeharmful199
Longhalflifeand
mayaccumulatein
milk198
Highlyplasma
proteinbound198
Largedosesmay
suppress
lactation197199
Cyclopenthaizide Amounttoosmall
tobeharmful199
Largedosesmay
suppress
lactation199
Indapamide Milksupply197 Noreportsof
Volume exposureviabreast
depletion 197 milk197
Manufacturer
suggestsavoid199
Maysuppress
lactation202
Metolazone Amounttoosmall
tobeharmful199
Largedosesmay
suppress
lactation199

Loopdiuretics

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Drugclass/name M:Pratio Relative Reportedpaediatric Monitoring Comments Other

infant concerns
dose
Furosemide 0.50.82 Nil197 Amounttoosmall
tobeharmful199
Veryunlikelythat
quantitytransmitted
inbreastmilk
wouldproduce
effectsinanursing
infant(relatively
highdosesused
therapeuticallyin
children)197
Largedosesmay
suppress
lactation197199
Torasemide Noreportsof
exposurethrough
breastmilk197
Highplasma
proteinbinding197
Mayreducemilk
supply197

Otherdiuretics
Amiloride Nohuman
exposureviabreast
milkreported202
Passageintomilkis
expected202

Betablockers
Propranolol 0.21.54 0.28%197 Nil197 Monitorfor Amountinbreast Circulatory
0.331.65 0.4%198 symptomsof milklow197 problemsand
(average beta Americanacademy Hypoglycaemia
0.5)197 blockade202 ofpaediatrics reportedin
classifiesas breastfeeding
compatiblewith infants198
breastfeeding202
Longtermeffects
oninfantnot
known202

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Drugclass/name M:Pratio Relative Reportedpaediatric Monitoring Comments Other

infant concerns
dose
Acebutolol 1.99.2 3.6%197 Symptomsofbeta Symptomsof Lowprotein Possible
(active blockadehavebeen beta bindingand toxicitydueto
metabolite observed(Hypotension, blockade202 primaryexcretion betablockade
2.324.7)197 bradycardia,tachypnoea viakidneys198 butamountof
252 and Possiblesignificant mostbeta
1.99.8(1.5 drowsiness)197198202 transfertobaby blockers
24.7active andaccumulation presentinmilk
metabolite)202 inpremature toosmallto
infants198199 affectinfant199

Atenolol 1.56.8197 6.6%197 Onereportedcaseof Symptomsof Lowprotein

1.16.8198 bradycardia,cyanosis beta bindingand
andhypothermia blockade202 primaryexcretion
required viakidneys198
hospitalisation197198202 Someauthorshave
failedtodetect
atenololinbreast
milk197
Possiblesignificant
transfertobaby
andaccumulation
inpremature
infants198199202
Bisoprolol Nil197 Hypotension, Noreportsofuse
bradycardia, inlactating
othersymptoms mothers202
ofbeta
blockade202
Carvedilol Hypotension, Nohumandata
bradycardia, available197202
othersymptoms Highlylipid
ofbeta solubleandlow
blockade202 molecularweight
transferintomilk
expected197
Labetalol 0.21.5198 0.57%197 Nil197202 hypotension Onlysmall
0.82.6197 andapnoea197 quantitiesexcreted
Hypotension, intobreast
bradycardia, milk197202
othersymptoms
ofbeta
blockade202

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Drugclass/name M:Pratio Relative Reportedpaediatric Monitoring Comments Other

infant concerns
dose
Metoprolol 33.72197 1.4%197 Nil197202 Hypotension, Concentratedin
weakness, breastmilkwith
bradycardiaand milklevelsapprox
197
othersymptoms timesthatof
ofbeta maternalplasma202
blockade197202 Maternalplasma
levelsaresmalland
soinfantdose
remainslow197
Nadolol 4.6197 4.6%197 Symptomsof Longhalflife197
beta Secretedintobreast
blockade202 milkinmoderately
highamounts,
possiblesignificant
transfertobaby
andaccumulation
inpremature
infants197199
Milklevels4.6
timesgreaterthan
maternalplasma202
Oxprenolol 0.140.45202 Nil202 Bradycardia Excretedinto
andother breastmilk,
symptomsof amountslikely
beta insignificantforthe
blockade202 infant202
Pindolol Bradycardia Manufacturerstates
andother presentinbreast
symptomsof milk202
beta Noreportsof
blockade202 exposurethough
breastmilk
reported202
Timolol 0.80.83202 1.1%197 Nil197202 Hypotension, Levelsinbreast
weakness, milkunlikelytobe
hypoglycaemia, significant197
sedationand
depression
Bradycardia
andother
symptomsof
beta
blockade202

Alphablockers

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Drugclass/name M:Pratio Relative Reportedpaediatric Monitoring Comments Other

infant concerns
dose
Doxazocin Noreportsofuse
inhuman
lactation202
Manufacturer
suggestsavoid199
Prazocin Noreportsofuse
inhuman
lactation202
Manufacturer
reportssmall
amountsinbreast
milk202
Amountprobably
toosmalltobe
harmful199
Mayreducemilk
production197
Terazosin Noreportsofuse
inhuman
lactation202
Transferintomilk
isexpected202

ACEinhibitors
Captopril 0.032 0.02%197 Nil197202 Hypotension197 Manufacturer
0.012197202 suggestsavoid199
Excretedinto
breastmilkinlow
concentrations202
Canbeusedin
breastfeeding202
whenfirstchoice
agentscannotbe
usedorare
ineffective(with
monitoring)197

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Drugclass/name M:Pratio Relative Reportedpaediatric Monitoring Comments Other

infant concerns
dose
Enalapril 00.14 0.17%197 Nil197 Hypotension197 Amountprobably
(0.0210.031 toosmalltobe
metabolite)202 harmful199202
0.013 Canbeusedin
0.025197 breastfeedingwhen
firstchoiceagents
cannotbeusedor
areineffective
(with
monitoring)197
Cautioninpreterm
infantsriskof
renaltoxicity197
Fosinopril Nil197 Barelydetectable
levelspresentin
breastmilk(no
valuesreported)197
Manufacturer
suggestsavoid199
Imidapril Manufacturer
suggestsavoid199
Lisinopril Noreportsofuse
duringhuman
lactation202
Excretioninto
humanbreastmilk
shouldbe
expected202
Manufacturer
suggestsavoid199
Moexipril Noreportsofuse
duringhuman
lactation202
Excretioninto
humanbreastmilk
shouldbe
expected202
Manufacturer
suggestsavoid199

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Drugclass/name M:Pratio Relative Reportedpaediatric Monitoring Comments Other

infant concerns
dose
Perindopril Noreportsofuse
duringhuman
lactation202
Excretioninto
humanbreastmilk
shouldbeexpected
(includingitsactive
metabolite)202
Manufacturer
suggestsavoid199
Quinapril 0.12197202 1.63 Nil197 Presentinbreast
milk202
Amountsavailable
inbreastmilk
clinically
insignificant202
Manufacturer
suggestsavoid199
Ramipril 0.25%197 Nil197 Hypotension197 Noreportsofuse
duringhuman
lactation202
Excretioninto
humanbreastmilk
shouldbe
expected202
Manufacturer
suggestsavoid199
Trandolapril Noreportsofuse
duringhuman
lactation202
Excretioninto
humanbreastmilk
shouldbe
expected202
Manufacturer
suggestsavoid199

AngiotensinIIreceptorblockers
Candesartan Noreportsofuse
duringhuman
lactation202
Excretioninto
humanbreastmilk
shouldbe
expected202
Manufacturer
suggestsavoid199
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Drugclass/name M:Pratio Relative Reportedpaediatric Monitoring Comments Other

infant concerns
dose
Eprosartan Noreportsofuse
duringhuman
lactation202
Excretioninto
humanbreastmilk
shouldbe
expected202
Manufacturer
suggestsavoid199
Irbesartan Noreportsofuse
duringhuman
lactation202
Excretioninto
humanbreastmilk
shouldbe
expected202
Manufacturer
suggestsavoid199
Losartan Noreportsofuse
duringhuman
lactation202
Excretioninto
humanbreastmilk
shouldbe
expected202
Manufacturer
suggestsavoid199
Olmesartan Noreportsofuse
duringhuman
lactation202
Excretioninto
humanbreastmilk
shouldbe
expected202
Manufacturer
suggestsavoid199
Telmesartan Noreportsofuse
duringhuman
lactation202
Excretioninto
humanbreastmilk
shouldbe
expected202
Manufacturer
suggestsavoid199

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Drugclass/name M:Pratio Relative Reportedpaediatric Monitoring Comments Other

infant concerns
dose
Valsartan Noreportsofuse
duringhuman
lactation202
Excretioninto
humanbreastmilk
shouldbe
expected202
Manufacturer
suggestsavoid199

Calciumchannelblockers
Amlodipine Nil197 Noreportsofuse
duringhuman
lactation202
Excretioninto
humanbreastmilk
shouldbe
expected197202
Manufacturer
suggestsavoid199
Diltiazem 0.20.92 0.8%197 Hypotension, Significantamount
13 bradycardia197 presentinmilkno
evidenceofharm
butavoidunlessno
saferalternative198
Presentinbreast
milkatsimilar
levelstothatof
maternalplasma202
Felodipine Noreportsofuse
duringhuman
lactation202
Excretioninto
humanbreastmilk
shouldbe
expected202
Isradipine Nil197 Hypotension, Manufacturer
fatigue, suggestsavoid199
bradycardiaand Noreportsofuse
apnoea197 duringhuman
lactation202
Excretioninto
humanbreastmilk
shouldbe
expected202

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Drugclass/name M:Pratio Relative Reportedpaediatric Monitoring Comments Other

infant concerns
dose
Lercanidipine Manufacturer
suggestsavoid199
Nicardipine 0.080.75197 0.07%197 Noreportsofuse
duringhuman
lactation202
Manufacturer
suggests
avoid199202
Nifedipine 13 1.83 Amounttoosmall
tobeharmful(but
manufacturer
suggests
avoid)199202
Verapamil 0.20.92 0.15 Nil197202 Hypotension, Amounttoosmall
0.94197 0.98% 197
bradycardia, tobeharmful199
weakness197

Otherantihypertensives
Clonidine 1.54 7.5%197 Nil197198202 Hypotension197 Mayreducemilk
23 production197
Manufacturer
suggestsavoid199
Methyldopa 0.20.52 0.11197 Nil197198 Amounttoosmall
0.190.34197 tobeharmful199
Moxonidine 12198 Manufacturer
suggestsavoid199
Hydralazine 0.491.36197 1.2%197 Nil197198202 Hypotension, Presentinmilkbut
0.52 sedation, notknowntobe
1.44 weakness197 harmful199202

From:AppendixO,Safetyofcommonlyusedantihypertensivedrugsduringbreastfeeding
HypertensioninPregnancy:TheManagementofHypertensiveDisordersDuringPregnancy.
NICEClinicalGuidelines,No.107.
NationalCollaboratingCentreforWomen'sandChildren'sHealth(UK).
London:RCOGPress2010Aug.

Copyright2011,RoyalCollegeofObstetriciansandGynaecologists.
Nopartofthispublicationmaybereproduced,storedortransmittedinanyformorbyanymeans,withoutthepriorwrittenpermissionofthepublisheror,inthe
caseofreprographicreproduction,inaccordancewiththetermsoflicencesissuedbytheCopyrightLicensingAgencyintheUK[www.cla.co.uk].Enquiries
concerningreproductionoutsidethetermsstatedhereshouldbesenttothepublisherattheUKaddressprintedonthispage.

Theuseofregisterednames,trademarks,etc.inthispublicationdoesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfromthe
relevantlawsandregulationsandthereforeforgeneraluse.

NCBIBookshelf.AserviceoftheNationalLibraryofMedicine,NationalInstitutesofHealth.

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