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


July 31, 2018 (Very Low Risk)

Propranolol is a non-cardioselective beta blocker usually given orally or intravenously, once or twice a day.
It is used in the management of hypertension, phaeochromocytoma, angina pectoris, myocardial infarction, cardiac arrhythmias, hypertrophic cardiomyopathy, to control symptoms of hyperthyroidism, anxiety disorders, and tremor. Other indications include the prophylaxis of migraine and of upper gastrointestinal bleeding in patients with portal hypertension.
Propranolol is also used in infants with tetralogy of Fallot and to treat infantile haemangiomas.

The pharmacokinetic characteristics of propranolol, especially its high percentage of plasma protein binding (Riant 1986), explain the negligible excretion observed in milk, much lower than the dose used for newborns and infants (Anderson 2018, Atkinson 1988, Livingstone 1983, Smith 1983, Thorley 1983, Taylor 1981, Bauer 1979, Anderson 1976, Karlberg 1974, Levitan 1973).

Propranolol has been used successfully in cases of persistent pain of the breast during breastfeeding (Muddana 2018).

Caution is needed if propranolol is used in mothers or infants with asthma. (Hale 2019, p 636).

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 (Anderson 2018).

Several medical societies, experts and expert consensus, consider the use of this medication safe during breastfeeding (Alexander 2017, Malachias 2016, Serrano 2014, Davanzo 2014, Rowe 2013, Pringsheim 2012, Ghanem 2008, Mahadevan 2006, WHO 2002, AAP 2001, Tan 2001, Shannon 2000, Taylor 1981, Lewis 1981).

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


We do not have alternatives for Propranolol 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.


  • beta-Propranolol
  • Propranolol Hydrochloride


  • Προπρανολόλη (Greek)
  • Пропранолола (Cyrillic)
  • プロプラノロール塩酸塩 (Japanese)
  • C16 H21 NO2, HCl (Molecular formula)
  • C07AA05 (ATC Code/s)
  • (±)-1-Isopropylamino-3-(1-naphthyloxy)propan-2-ol hydrochloride ()


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