Diltiazem vs. nifedipine

[Cami]

I had well controlled bp before my pregnancy on lisinopril/hctz. I had been prescribed it about 8 months before trying to conceive. Stopped it to conceive, and was unmedicated with good readings until around 30 weeks. Then I was placed on labetalol, increasing doses for the rest of the pregnancy and postpartum. The labetalol did not work well in keeping my pressure down. I am almost 8 weeks postpartum and breastfeeding exclusively and successfully. (child #5). My provider prescribed diltiazem extended release. She consulted the pharmacist who recommended nifedipine but she prescribed diltiazem anyway. (I found this out after the fact) When I went to fill the prescription, the pharmacist cautioned me that diltiazem was contraindicated for breastfeeding. He had several sources he was looking at including, including the manufacture. My provider gave me an article from Up To Date that said diltiazem and nefedipine are both probably okay but the pharmacist said his Up To Date said no. I didn't fill the prescription (still weaning off labetalol) and have been looking for information since. It seems I've found more on nifidipine. Why would some sources say diltiazem is okay and others not? Should I request nifedipine or just fill the diltiazem prescription? Is one safer and less likely to affect my baby than the other? My pressures have been in the 150-180's range, diastole less than 100. Thank you very much for your time.

[admin]

Cami:

While nifedipine is considered ideal for breastfeeding women, the dose of diltiazem to the infant, is quite low. Only 0.875% of your dose would get to the infant. I'd stay with you doctors suggested drug. Observe the infant for weakness, difficulty to arouse, etc, but I'm certain you won't see any complications at all.

Tom Hale Ph.d.
InfantRisk Center