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

Captopril

August 28, 2018 (Very Low Risk)

Captopril is an angiotensin converting enzyme (ACE) inhibitor used in the treatment of hypertension, heart failure, myocardial infarction and type I diabetic nephropathy.
Oral administration every 8-12-24 hours.

It is excreted in breastmilk in clinically insignificant amounts (Anderson 2018, FT 2018, Serrano 2015, Drummer 1986, Devlin 1981) and no problems have been observed in infants whose mothers were taking it (Anderson 2018, Devlin 1981).

Due to its possible renal toxicity in preterm infants, it is preferable to avoid its use during the neonatal period in the case of prematurity. (Serrano 2015).

Expert authors and medical associations such as the American Academy of Pediatrics consider it to be a drug which is usually compatible with breastfeeding (Serrano 2015, Rowe 2013, Dennis 2012, Ghanem 2008, AAP 2001, Kirsten 1998).
List of WHO essential medicines: compatible with breastfeeding (WHO / UNICEF 2002).

The protective role of breastfeeding against maternal hypertension has been proven (Park 2018).

Alternatives

We do not have alternatives for Captopril since it is relatively safe.

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

  • Καπτοπρίλη (Greek)
  • كابتوبريل (Arabic)
  • Каптоприл (Cyrillic)
  • 卡托普利 (Chinese)
  • カプトプリル (Japanese)
  • C9 H15 NO3 S (Molecular formula)
  • 1-[(2S)-3-Mercapto-2-methylpropionyl]-l-proline (Chemical name)
  • C09AA01 (ATC Code/s)

References

  1. Anderson PO. Treating Hypertension During Breastfeeding. Breastfeed Med. 2018Abstract
  2. AEMPS. Captopril. Ficha técnica. 2017 Full text (in our servers)
  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. Serrano Aguayo P, García de Quirós Muñoz JM, Bretón Lesmes I, Cózar León MV. Tratamiento de enfermedades endocrinológicas durante la lactancia. [Endocrinologic diseases management during breastfeeding.] Med Clin (Barc). 2015Abstract
  5. FDA. Captopril. Drug Summary. 2014 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. Dennis AT. Management of pre-eclampsia: issues for anaesthetists. Anaesthesia. 2012Abstract Full text (link to original source) Full text (in our servers)
  8. 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)
  9. 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)
  10. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001Abstract Full text (link to original source) Full text (in our servers)
  11. Kirsten R, Nelson K, Kirsten D, Heintz B. Clinical pharmacokinetics of vasodilators. Part II. Clin Pharmacokinet. 1998Abstract
  12. Denolle T, Rohmer V, Saint-Adnré JP, Guyene TT, Galland F, Bigorgne JC, Schambelan M, Corvol P. Effect of the circulating renin-angiotensin system on prolactin release in humans. J Clin Endocrinol Metab. 1990Abstract
  13. Saito I, Takeshita E, Hayashi S, Takenaka T, Murakami M, Saruta T, Nagano S, Sekihara T. Effect of captopril on plasma prolactin in patients with essential hypertension. Angiology. 1990Abstract
  14. Anderson PW, Malarkey WB, Salk J, Kletsky OA, Hsueh WA. The effect of angiotensin-converting enzyme inhibition on prolactin responses in normal and hyperprolactinemic subjects. J Clin Endocrinol Metab. 1989Abstract
  15. Duchin KL, McKinstry DN, Cohen AI, Migdalof BH. Pharmacokinetics of captopril in healthy subjects and in patients with cardiovascular diseases. Clin Pharmacokinet. 1988Abstract
  16. Drummer OH, Jarrott B. The disposition and metabolism of captopril. Med Res Rev. 1986Abstract
  17. Devlin RG, Fleiss PM. Captopril in human blood and breast milk. J Clin Pharmacol. 1981Abstract