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

Enalapril

June 9, 2018 (Very Low Risk)

Enalapril is an angiotensin converting enzyme (ACE) inhibitor used in the treatment of high blood pressure and heart failure.
Oral administration every 12-24 hours.

It is excreted in breastmilk in clinically insignificant amounts (Anderson 2018, Serrano 2015, Rush 1991, Redman 1990, Kirsten 1998, Huttunen 1989) and no problems have been observed in infants whose mothers were taking it (Anderson 2018, Rush 1991, Huttunen 1989 ), nor problems in the establishment of breastfeeding (Bach 1995).

It use is authorized in small infants and, off-label, in neonates. (FDA 2018, Kirsten 1998)

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).

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

Alternatives

We do not have alternatives for Enalapril 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.

Synonyms

Enalapril Maleate

Writings

Εναλαπρίλη (Greek)
إينالابريل (Arabic)
Эналаприл (Cyrillic)
依那普利 (Chinese)
エナラプリル (Japanese)
C20 H28 N2 O5, C4 H4 O4 (Molecular formula)
N-{N-[(S)-1-Ethoxycarbonyl-3-phenylpropyl]-l-alanyl}-l-proline hydrogen maleate (Chemical name)
C09AA02 (ATC Code/s)

Drug trade names

References

Park S, Choi NK. Breastfeeding and Maternal Hypertension. Am J Hypertens. 2018Abstract
AEMPS. Enalapril. Ficha técnica. 2018 Full text (in our servers)
FDA. Enalapril. Drug Summary. 2018 Full text (in our servers)
Anderson PO. Treating Hypertension During Breastfeeding. Breastfeed Med. 2018Abstract
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)
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
Dennis AT. Management of pre-eclampsia: issues for anaesthetists. Anaesthesia. 2012Abstract Full text (link to original source) Full text (in our servers)
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)
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)
Kirsten R, Nelson K, Kirsten D, Heintz B. Clinical pharmacokinetics of vasodilators. Part II. Clin Pharmacokinet. 1998Abstract
Bach N. [Enalapril treatment of a pre-eclamptic woman]. Ugeskr Laeger. 1995Abstract
Rush JE, Snyder DL, Barrish A, Hichens M. Comment on Huttunen K, Grönhagen-Riska C and Fyhrquist F, 1989. Enalapril treatment of a nursing mother with slightly impaired renal function. Clin Nephrol 31: 278. Clin Nephrol. 1991Abstract
Redman CW, Kelly JG, Cooper WD. The excretion of enalapril and enalaprilat in human breast milk. Eur J Clin Pharmacol. 1990Abstract
Huttunen K, Grönhagen-Riska C, Fyhrquist F. Enalapril treatment of a nursing with slightly impaired renal function. Clin Nephrol. 1989Abstract