Lisinipril HCTZ combo

[Cordeliasmom]

I am battling high blood pressure and take 200mg Labetalol 2x a day as well as a pill that contains 20 mg Lisinipril and 25 mg hydrochlorothiazide once a day. My doctor wants me to wean my 11 1/2 month old ,my mother in law was telling my husband that I should wean her as well,my hubby and I would rather I continue breastfeeding until our little one is ready to wean on her own. What are the risk with these meds??

[cpride]

Dear Cordeliasmom,

Labetalol is compatible with breastfeeding. The amount of labetalol secreted into breastmilk is 0.2 % to 0.6 % of your dose which is very small. The time the drug is most concentrated in your milk is one to two hours after you take your dose. You can breastfeed first then take your dose to decrease the amount of drug that the child would be exposed to. Also, because your child is older the amount of milk ingested is less because he/she is also taking solids etc. You should observe for tiredness and color changes that would indicate low blood pressure or low heart rate, but these are not likely because of the small amount of drug in your breastmilk and the age of your child. We do not have data on lisinipril so we do not know how much of the drug gets into breasmilk. Enalapril, which is in the same class of drugs (ACE inhibitors) as lisinipril, has 0.2 % of the dose that passes into breastmilk which again is small. You may talk with your physician to see if you could change to enalapril or captopril because we do have data on those. ACE inhibitors should not be used in premature infants due to renal toxicity, but your child would have little risk since he/she is older. The time enalapril is most concentrated in your milk would be 30 minutes to one and one half hours after your dose. Hydrochlorothiazide diuretics are compatible with breastfeeding if the doses are kept low, and your dose is low. The dosing range is 25 to 100 mg daily. Less than 50 mcg per day would be available in your breastmilk. The time hydrochlorothiazide is most concentrated in your milk is two hours after your dose. Diuretics have the potential to decrease milk supply due to decreasing mother's blood volume, but this is seldom observed. Let me know if you have further questions.

Sincerely,
Cindy Pride, MSN,CPNP
TTUHSC InfantRisk Center