Choice of antihypertensive agents during lactation

Approximately 14% of women 20-54 years of age have hypertension. Some of these women need antihypertensive treatment postpartum, and wish to breastfeed. Many drugs taken by the mother eventually appear in human milk. The drug level in milk depends on the physiochemical properties of the drug, the degree of plasma protein binding, acid-base characteristics, lipid solubility and the maternal serum concentration. Both the clinician and the mother have to weigh the risk to benefit ratio when maternal medication is prescribed. This article discusses the antihypertensive medication with regard to lactation by the maternal milk to plasma (M/P) ratios and indicates the choice of agents for the mother and infants. It seems reasonable to avoid diuretics, because of their potential to suppress lactation. By the available data to date, Methyldopa, beta blocker with high plasma protein binding (ex propranolol), captopril, enalapril, and some calcium channel blockers are safe treatments of hypertension in a nursing mother, especially with slowly increasing dose and feeding 3-4 hours after taking antihypertensive medicine.