Enalapril

[ATHamilton]

I'm nursing an 11 week old infant, and am currently taking labetalol and cardizem. My nephrologist wants to put me back on Enalapril for FSGS.

I'm finding conflicting information on the internet about the safety of Enalapril for a nursing infant. Some information says that it is excreted in small amounts and isn't known to cause problems. But both my nephrologist and our pediatrician say that it isn't approved for lactation.

I very much want to keep nursing, and am weighing my options. Any advice would be very much appreciated.

Thank you in advance,
Allison Hamilton

[admin]

allison:

First, NO drug is approved from breastfeeding mothers, and we all know that this is simply crazy. Most all drugs are safe to use.

Below is what we do know.


Tom Hale Ph.D.

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Enalapril maleate is an ACE inhibitor used as an antihypertensive. Upon absorption, it is rapidly metabolized by the adult liver to enalaprilat, the biologically active metabolite. In one study of 5 lactating mothers who received a single 20 mg dose, the mean maximum milk concentration of enalapril and enalaprilat was only 1.74 µg/L and 1.72 µg/L respectively.[1] The author suggests that an infant consuming 850 mL of milk daily would ingest less than 2 µg of enalapril daily. The milk/plasma ratios for enalapril and enalaprilat averaged 0.013 and 0.025 respectively. However, this was only a single dose study, and the levels transferred into milk at steady state may be slightly higher.

In a study by Rush of a patient receiving 10 mg/day, the total amount of enalapril and enalaprilat measured in milk during the 24 hour period was 81.9 ng and 36.1 ng respectively or 1.44 µg/L and 0.63 µg/L of milk respectively.[2] Some caution is recommended in using ACE inhibitors in mothers with premature infants due to possible renal toxicity.

1.Redman CW, Kelly JG, Cooper WD. The excretion of enalapril and enalaprilat in human breast milk. Eur J Clin Pharmacol 1990; 38(1):99.
2.Rush JE, Snyder BA, Barrish A. et.al. Comment. Clin Nephrol 1991; 35:234.