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Another lisinopril question

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  • Another lisinopril question

    I was prescribed lisinopril this week for proteinuria, but I haven’t started yet because I was told I’d have to wean and I don’t want to do that any sooner than six months. She is turning five months this week. I have been checking LactMed and Dr Newman and here, and I have seen varying answers. I read that medications that are too big to pass into the milk are safe, and others that are protein-bound are safe, but neither apply to lisinopril. I have seen in the forums that Dr. Hale finds lisinopril safe, but can you please help me understand what makes lisinopril safe? Also would it be better for me to ask for a “safer” medication? LactMed recommends not using lisinopril and instead trying one of these: benazepril, captopril, enalapril, or quinapril. However, I have not yet spoken to my dr about these alternatives to see if they would even work for me. Thank you.
    Last edited by Starrlight97; 01-01-2021, 09:06 PM.

  • #2

    You are correct that we don't have any clear data on the use of this antihypertensive in breastfed infants, despite that we think it is pretty safe. First, I often look at the chemistry of these drugs. Lisinopril is rather acidic, rather larger in molecular weight, and is poorly absorbed orally (<25%). The last characteristic is important, as only 25% of an oral dose is absorbed. All these together suggest to me that milk levels will be subclinical or very low and probably have no effect on your infant.

    If you decide to continue breastfeeding with this antihypertensive, and I hope you do, then perhaps you could provide my laboratories with milk samples that we could assay and help the next mom that asks about this drug. If so, click on the link below.

    As for the other ACE inhibitors, they are all poorly transferred into milk, but we have some data on some of them which again suggests milk levels are exceedingly low.

    Tom Hale Ph.D.