Excretion of antihypertensive medication into human breast milk: a systematic review.
OBJECTIVE
To establish which antihypertensive medications are safe for use while breastfeeding, by reviewing the available evidence.


METHODS
Reports of studies examining the transfer of antihypertensive medications to breastmilk were identified from multiple MEDLINE and EMBASE searches, manual review of bibliographies of articles and textbooks on drug use during lactation. The reports were reviewed and the results were compiled.


RESULTS
Prospective cohort studies and case reports constituted the only available evidence. Compilation of these results found that the milk to plasma (M/P) ratios varied widely across the beta-blocker family, the beta-blockers with low protein binding having the highest M/P ratios. The angiotensin-converting enzyme (ACE) inhibitors, methyldopa, and some calcium channel blockers had low M/P ratios.


CONCLUSIONS
The available data to date indicate that ACE inhibitors, methyldopa, beta-blockers with high protein binding, and some calcium channel blockers all appear to be safe treatments of hypertension in a nursing mother. The data suggest that drugs to be avoided are beta-blockers with low protein binding. However, the available evidence is limited and further studies are needed to confirm these findings.
Beardmore
Kate S
KS
Northern Clinical School, Sydney University, Royal North Shore Hospital, St. Leonards, NSW 2065, Australia.
Morris
Jonathan M
JM
Gallery
Eileen D M
ED
D000319:Adrenergic beta-Antagonists / Q000032:analysis / Q000493:pharmacokinetics; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000032:analysis / Q000493:pharmacokinetics; D000959:Antihypertensive Agents / Q000032:analysis* / Q000493:pharmacokinetics*; D001942:Breast Feeding; D002121:Calcium Channel Blockers / Q000032:analysis / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007774:Lactation / Q000378:metabolism*; D008750:Methyldopa / Q000032:analysis / Q000493:pharmacokinetics; D008895:Milk, Human / Q000737:chemistry*
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D008750:Methyldopa