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


August 29, 2018 (Very Low Risk)

Metoprolol is a cardioselective beta blocker used in the management of hypertension, angina pectoris, cardiac arrhythmias, myocardial infarction, heart failure, hyperthyroidism and prophylactic treatment of migraine.
Administration orally or intravenously in 1-4 daily doses.

Although Metoprolol is a weak base (pKa 9.7) with low plasma protein binding and moderate lipid solubility and for this the milk/plasma ratios for metoprolol are in general high (Ryu 2016, Kulas 1984, Lindeberg 1984, Liedholm 1981, Sandstorm 1983 & 1980), the maternal plasma levels are very low, so it is excreted in breast milk in clinically insignificant amounts (Hale 2019, p 505, Ryu 2016, AEMPS 2016, Astra 2014, Yep 2011, Kulas 1984, Lindeberg 1984, Sandstorm 1983, 1980 & 1978).

The concentration of metoprolol in infant plasma has been found to be undetectable or very low and unlikely to be clinically significant for infants (Grundmann 2011, Kulas 1984, Lindeberg 1984, Sandstrom 1983).

No adverse effects have been seen in breast-fed infants whose mothers were given metoprolol (Briggs 2017)

Some authors do not consider beta-blockers to be drugs of choice for the treatment of hypertension, unless another indication exists simultaneously, such as migraine or angina prophylaxis. Caution is needed if metoprolol is used in mothers or preterm infants (Anderson 2018).

Several medical societies, experts and expert consensus, consider the use of this medication safe or probably safe during breastfeeding (Alexander 2017, Malachias 2016, Serrano 2014, Davanzo 2014, Rowe 2013, Pringsheim 2012, Ghanem 2008, Tan 2001, Shannon 2000).
The American Academy of Pediatrics considers that it is a medication usually compatible with breast feeding (AAP 2001).

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


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.


  • Metoprolol fumarate
  • Metoprolol succinate
  • Metoprolol tartrate


  • Μετοπρολόλη (Greek)
  • ميتوبرولول (Arabic)
  • Метопролол (Cyrillic)
  • 美托洛尔 (Chinese)
  • C15 H25 NO3 (Molecular formula)
  • (±)-1-Isopropylamino-3-[4-(2-methoxyethyl)phenoxy]propan-2-ol IUPAC 1-[4-(2-methoxyethyl)phenoxy]-3-[(propan-2-yl)amino]propan-2-ol (Chemical name)
  • C07AB02 (ATC Code/s)


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