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

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).

Alternatives

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.

Synonyms

  • beta-Propranolol
  • Propranolol Hydrochloride

Writings

  • 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 ()

References

  1. Hale TW. Hale's Medications & Mothers' Milk. Springer Publishing Company. 2019
  2. Anderson PO. Treating Hypertension During Breastfeeding. Breastfeed Med. 2018Abstract
  3. Muddana A, Asbill DT, Jerath MR, Stuebe AM. Quantitative Sensory Testing, Antihistamines, and Beta-Blockers for Management of Persistent Breast Pain: A Case Series. Breastfeed Med. 2018Abstract
  4. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017Abstract Full text (link to original source) Full text (in our servers)
  5. 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)
  6. 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
  7. Davanzo R, Bua J, Paloni G, Facchina G. Breastfeeding and migraine drugs. Eur J Clin Pharmacol. 2014Abstract
  8. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. 2013Abstract
  9. FDA-Akrimax. Propranolol (Innopran) Drug Summary. 2013 Full text (in our servers)
  10. AEMPS- Astra Zeneca. Propranolol (Sumial). Ficha técnica. 2012 Full text (in our servers)
  11. Pringsheim T, Davenport W, Mackie G, Worthington I, Aubé M, Christie SN, Gladstone J, Becker WJ; Canadian Headache Society Prophylactic Guidelines Development Group. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2012Abstract Full text (in our servers)
  12. Tamargo Menéndez J, Delpón Mosquera E. Farmacología de los bloqueantes de los receptores β-adrenérgicos. Curso βeta 2011 de Actualización en Betabloqueantes. 2011 Full text (in our servers)
  13. 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)
  14. Mahadevan U, Kane S. American gastroenterological association institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006Abstract Full text (link to original source) Full text (in our servers)
  15. 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)
  16. 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)
  17. Tan HL, Lie KI. Treatment of tachyarrhythmias during pregnancy and lactation. Eur Heart J. 2001Abstract Full text (link to original source) Full text (in our servers)
  18. Shannon ME, Malecha SE, Cha AJ. Beta blockers and lactation: an update. J Hum Lact. 2000Abstract
  19. Kirsten R, Nelson K, Kirsten D, Heintz B. Clinical pharmacokinetics of vasodilators. Part II. Clin Pharmacokinet. 1998Abstract
  20. Atkinson HC, Begg EJ, Darlow BA. Drugs in human milk. Clinical pharmacokinetic considerations. Clin Pharmacokinet. 1988Abstract
  21. Riant P, Urien S, Albengres E, Duche JC, Tillement JP. High plasma protein binding as a parameter in the selection of betablockers for lactating women. Biochem Pharmacol. 1986Abstract
  22. Thorley KJ, McAinsh J. Levels of the beta-blockers atenolol and propranolol in the breast milk of women treated for hypertension in pregnancy. Biopharm Drug Dispos. 1983Abstract
  23. Smith MT, Livingstone I, Hooper WD, Eadie MJ, Triggs EJ. Propranolol, propranolol glucuronide, and naphthoxylactic acid in breast milk and plasma. Ther Drug Monit. 1983Abstract
  24. Livingstone I, Craswell PW, Bevan EB, Smith MT, Eadie MJ. Propranolol in pregnancy three year prospective study. Clin Exp Hypertens B. 1983Abstract
  25. Lewis AM, Patel L, Johnston A, Turner P. Mexiletine in human blood and breast milk. Postgrad Med J. 1981Abstract Full text (link to original source) Full text (in our servers)
  26. Taylor EA, Turner P. Anti-hypertensive therapy with propranolol during pregnancy and lactation. Postgrad Med J. 1981Abstract Full text (link to original source) Full text (in our servers)
  27. Bauer JH, Pape B, Zajicek J, Groshong T. Propranolol in human plasma and breast milk. Am J Cardiol. 1979Abstract Full text (link to original source)
  28. Anderson PO, Salter FJ. Letter: Propranolol therapy during pregnancy and lactation. Am J Cardiol. 1976Abstract Full text (link to original source)
  29. Karlberg B, Lundberg D, Aberg H. Letter: Excretion of propranolol in human breast milk. Acta Pharmacol Toxicol (Copenh). 1974Abstract
  30. Levitan AA, Manion JC. Propranolol therapy during pregnancy and lactation. Am J Cardiol. 1973Abstract Full text (link to original source)