Nebivolol

A beta receptor antagonist, which reduces heart rate and blood pressure. Indicated in the treatment of arterial hypertension (AHT) and chronic heart failure.
Oral administration once a day.

Since the last update we have not found published data on its excretion in breastmilk.

Its pharmacokinetic data (very high percentage of protein binding and large volume of distribution) make transfer to milk in significant quantities unlikely.

It is metabolized through the CYP2D6 isoenzyme. There are fast metabolizing persons (the majority) and other slow ones. Slow metabolism implies an 8-fold higher bioavailability (almost complete), higher plasma concentrations and an elimination half-life up to three times longer than those of rapid metabolizers (AEMPS 2017, FDA 2010), which could lead to greater excretion in breastmilk.

The excretion capacity in milk of beta-blockers is marked by its percentage of protein binding which varies considerably from one to another (Anderson 2018, Tamargo 2011, Riant 1986).
Beta-blockers are not considered the treatment of choice for hypertension unless migraine or angina prophylaxis coexists (Anderson 2018).

Until there is more published information on this drug in relation to breastfeeding, known alternatives with a safer pharmacokinetic profile during breastfeeding may be preferable, both in the same group of antihypertensives and others (Anderson 2018, Malachias 2016, Serrano 2015), especially in the neonatal period and in case of prematurity.

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

Alternatives

• Labetalol Hydrochloride (Very Low Risk)
• Methyldopa (Very Low Risk)
• Enalapril (Very Low Risk)
• Metoprolol (Very Low Risk)
• Captopril (Very Low Risk)
• Oxprenolol (Very Low Risk)
• Propranolol (Very Low Risk)