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One of my clients was prescribed Atenolol by an ER physician for dangerously hypertension at three months postpartum. She is exclusively breastfeeding her infant. When she went to fill the prescription, the pharmacist advised her to quit breastfeeding if she took the drug. My research shows that it is not recommended by AAP with breastfeeding, but some research has found no problems with atenolol and breastfeeding. Has anyone had adverse effects in the infant with atenolol?
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Dear jordancnm,
Atenolol is one of the few beta blockers that produces significant adverse effects in breastfed infants. Observe for tiredness and poor feeding in the breastfed infant. More suitable beta blockers are metoprolol and propranolol. Propranolol has the lowest relative infant dose (amount of maternal dose that is present in breastmilk) at 0.3 percent to 0.5 percent, and metoprolol only has 1.4 percent compared to 6.6 percent for atenolol. For propranolol, the mother should wait one and one-half hours after dose to return to breastfeeding. For metoprolol, she should wait two and one-half to three hours after her dose to breastfeed. If her physician won't change her medication, she may wait past the first half-life of atenolol (six hours) before breastfeeding to reduce risk to her infant.
Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center
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