Ace Inhibitors & Beta Blockers and breastfeeding

[sandejosgirl]

I was dx with breast cancer in Mar of 2011 and was treated with mastectomy, dose dense AC-T and radiation. My son was born June 2nd of this year and I have just been diagnosed with systolic heart failure due to my BC treatment.

I spoke to Infant Risk and they gave me the info on the two drugs proscribed: enalapril (the ace inhibitor) & metoprolol, both (the beta blocker) L2 meds. However, I am concerned about breastfeeding my son with no information on how taking both, not each separately as they are rated, will effect my almost 5 month old (full term). My cardiologist said no breastfeeding (he did not contact you or look up the information) and separately the meds are ok to take with observation of side effects.

Please let me know if any information is known about the combo of ace inhibitors and beta blockers on breastfeeding infants.

[sandejosgirl]

I forgot to give dosages: 25mg once daily of metoprolol and 5mg twice daily of enalapril

[admin-james]

Hi, thanks for your post.

I can understand why you would have some apprehension about using these medications together since they both lower blood pressure. However, let me point out a few things that suggest you are in a low risk situation:

1. These two medications act in different ways. The end result is lower blood pressure but they do not mix or produce abnormally large effects when used together.
2. You are on the lowest end of the dosage range for both of these drugs. The breastfeeding safety studies of each drug independently were done at doses 2-4x what you are taking. Those babies did just fine.
3. Enalapril is prescribed directly to infants at doses of up to 40mg per day. Your baby is probably going to ingest around 0.01mg per day from your milk. Similarly, metoprolol is prescribed to children >1 year old at doses up to 200mg per day. Your baby will get around 0.25mg from your milk.
4. The most likely side effects (which I would be *very* surprised to see in your baby) are not life-threatening and do no permanent damage. The benefits of breastfeeding FAR outweigh the risks in this case.

Please call us at the InfantRisk Center if this has not completely answered your question.*(806)352-2519

-James Abbey, MD