12 hour pump & dump on lisinopril

[wiclc]

I have a mother that has been exculsively breastfeeding her 1 month old and was advised by the pediatrician to take her lisinopril at 8am, then pump & dump till 8pm, then can breastfeed through the night. She is upset and will follow drs advice, but can we give her some other information? Is the pump & dump schedule necessary? Please advise.
Sonja Beck, IBCLC, RLC
WIC Breastfeeding Coordinator

[cpride]

Dear wiclc,

Lisinopril is a typical long-acting ACE inhibitor used as an antihypertensive. We have no data on lisinopril transfer into milk. Other ACE inhibitors such as enalapril are probably safe to use during breastfeeding and transfer is minimal. The medication is only 29 percent absorbed orally so the infant would not be able to absorb much of the medication in the breastmilk. Monitor for hypotension, tiredness, and poor feeding. The time the medication is highest (Tmax) is 7 hours after the dose so have mom should avoid breastfeeding during that time. The half-life is 12 hours so half of the medication should be metabolized within that length of time. Dr. Hale thinks this medication is probably safe during breastfeeding. This mother may want to talk with her pediatrician about adding another breastfeeding every few days while continuing to monitor for lethargy and poor feeding until on a full breastfeeding schedule (except for avoiding the T max). She may also talk with her pediatrician about having the infant's blood pressure monitored for a few weeks in the pediatrician's office to ensure the infant is doing well as the breastfeeding is increased. If the mother or pediatrician has questions, please have them call us at the InfantRisk Center, 806-352-2519. We are open Monday through Friday, 8 to 5, CDT.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center