Is Atenolol compatible with breastfeeding? Do we have alternatives for Atenolol?

Atenolol

August 30, 2018 (High Risk)

A cardioselective beta-blocker used in the treatment of high blood pressure (HBP), angina pectoris, myocardial infarction, cardiac arrhythmias and in the prophylaxis of migraine.
Oral administration once a day.

It is excreted in breastmilk in varying quantities but which could be clinically significant (Lwin 2018, Eyal 2010, Hebert 2005, Schmimmel 1989, Atkinson 1988, Kulas 1984, Thorley 1983).

Varying levels have been measured in the plasma or urine of infants whose mothers were taking it (Schmimmel 1989, Fowler 1984, Thorley 1983, Liedholm 1982 and 1981), although some authors have not found detectable levels in the plasma or urine of infants (Eyal 2010, Kulas 1984, White 1984).

No problems have been observed in infants whose mothers were taking this medication (Eyal 2010, Kulas 1984, White 1984, Fowler 1984, Thorley 1983, Liedholm 1982) except for a newborn who, at 5 days of age, presented bradycardia, cyanosis and hypothermia; the mother was taking 50 mg/12 hours of atenolol for postpartum hypertension; the symptoms disappeared when the mother discontinued the medication (Schmimmel 1989).

Hyperprolactinemia and galactorrhea have been observed with the use of atenolol (Lee 1982).

Within the same group, there are drugs with a safer pharmacokinetic profile for breastfeeding (higher protein binding, shorter half-life and lower oral bioavailability: Tamargo 2011, Riant 1986) and that are known not to cause problems during breastfeeding (Anderson 2018).

Safer alternatives are preferred during breastfeeding, especially during the neonatal period and in case of prematurity (Lwin 2018, Malachias 2016, Davanzo 2014, Hutchinson 2013, Rowe 2013, Ghanem 2008, Hale 2003, WHO 2002, Shannon 2000).

Alternatives

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Writings

  • أتينولول (Arabic)
  • Атенолол (Cyrillic)
  • 阿替洛尔 (Chinese)
  • アテノロール (Japanese)
  • Aténolol (French)
  • C14 H22 N2 O3 (Molecular formula)
  • 2-{p-[2-Hydroxy-3-(isopropylamino)propoxy]phenyl}acetamide (Chemical name)
  • C07AB03 (ATC Code/s)

References

  1. Lwin EMP, Gerber C, Leggett C, Song Y, Ritchie U, Turner S, Hague W, Upton R, Garg S. Estimation of Atenolol Transfer Into Milk and Infant Exposure During Its Use in Lactating Women. J Hum Lact. 2018Abstract
  2. Anderson PO. Treating Hypertension During Breastfeeding. Breastfeed Med. 2018Abstract
  3. Malachias MV, Figueiredo CE, Sass N, Antonello IC, Torloni MR, Bortolotto MRF L. 7th Brazilian Guideline of Arterial Hypertension: Chapter 9 - Arterial Hypertension in pregnancy Arq Bras Cardiol. 2016Abstract Full text (link to original source) Full text (in our servers)
  4. Davanzo R, Bua J, Paloni G, Facchina G. Breastfeeding and migraine drugs. Eur J Clin Pharmacol. 2014Abstract
  5. Hutchinson S, Marmura MJ, Calhoun A, Lucas S, Silberstein S, Peterlin BL. Use of common migraine treatments in breast-feeding women: a summary of recommendations. Headache. 2013Abstract Full text (link to original source) Full text (in our servers)
  6. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. 2013Abstract
  7. Tamargo Menéndez J, Delpón Mosquera E. Farmacología de los bloqueantes de los receptores β-adrenérgicos. Curso βeta 2011 de Actualización en Betabloqueantes. 2011 Full text (in our servers)
  8. Eyal S, Kim JD, Anderson GD, Buchanan ML, Brateng DA, Carr D, Woodrum DE, Easterling TR, Hebert MF. Atenolol pharmacokinetics and excretion in breast milk during the first 6 to 8 months postpartum. J Clin Pharmacol. 2010Abstract Full text (in our servers)
  9. Ghanem FA, Movahed A. Use of antihypertensive drugs during pregnancy and lactation. Cardiovasc Ther. 2008Abstract Full text (link to original source) Full text (in our servers)
  10. Hebert MF, Carr DB, Anderson GD, Blough D, Green GE, Brateng DA, Kantor E, Benedetti TJ, Easterling TR. Pharmacokinetics and pharmacodynamics of atenolol during pregnancy and postpartum. J Clin Pharmacol. 2005Abstract
  11. Hale TW. Medications in breastfeeding mothers of preterm infants. Pediatr Ann. 2003Abstract
  12. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  13. Shannon ME, Malecha SE, Cha AJ. Beta blockers and lactation: an update. J Hum Lact. 2000Abstract
  14. Eidelman AI, Schimmel MS. Drugs and breast milk. Pediatrics. 1995Abstract
  15. Lee ST. Hyperprolactinemia, galactorrhea, and atenolol. Ann Intern Med. 1992Abstract
  16. Schimmel MS, Eidelman AI, Wilschanski MA, Shaw D Jr, Ogilvie RJ, Koren G. Toxic effects of atenolol consumed during breast feeding. J Pediatr. 1989Abstract
  17. Atkinson HC, Begg EJ, Darlow BA. Drugs in human milk. Clinical pharmacokinetic considerations. Clin Pharmacokinet. 1988Abstract
  18. Riant P, Urien S, Albengres E, Duche JC, Tillement JP. High plasma protein binding as a parameter in the selection of betablockers for lactating women. Biochem Pharmacol. 1986Abstract
  19. White WB, Andreoli JW, Wong SH, Cohn RD. Atenolol in human plasma and breast milk. Obstet Gynecol. 1984Abstract
  20. Fowler MB, Brudenell M, Jackson G, Holt DW. Essential hypertension and pregnancy: successful outcome with atenolol. Br J Clin Pract. 1984Abstract
  21. Kulas J, Lunell NO, Rosing U, Stéen B, Rane A. Atenolol and metoprolol. A comparison of their excretion into human breast milk. Acta Obstet Gynecol Scand Suppl. 1984Abstract
  22. Thorley KJ, McAinsh J. Levels of the beta-blockers atenolol and propranolol in the breast milk of women treated for hypertension in pregnancy. Biopharm Drug Dispos. 1983Abstract
  23. Liedholm H, Wåhlin-Boll E, Hanson A, Ingemarsson I, Melander A. Transplacental passage and breast milk concentrations of hydralazine. Eur J Clin Pharmacol. 1982Abstract
  24. Liedholm H, Melander A, Bitzén PO, Helm G, Lönnerholm G, Mattiasson I, Nilsson B, Wåhlin-Boll E. Accumulation of atenolol and metoprolol in human breast milk. Eur J Clin Pharmacol. 1981Abstract