Last update: Jan. 15, 2019
Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
Read the Comment.
Bisoprolol fumarate is a cardioselective beta-blocker that is administered orally once a day in the treatment of hypertension and angina pectoris, in patients with stable chronic heart failure and in the secondary prevention of myocardial infarction (AEMPS 2015, FDA 2007).
In a published case of a woman who started taking bisoprolol at 6 days postpartum, bisoprolol levels were undetectable (<1 mcg/L) in all milk samples 11-18 days after initiation (Khurana 2014).
The pharmacokinetic characteristics of bisoprolol: low percentage of plasma protein binding (AEMPS 2015, FDA 2007, Leopold 1986), moderate liposolubility, long half-life and relatively high renal excretion (FDA 2007) make bisoprolol less favorable for breastfeeding mothers, compared to other beta blockers (Kearney 2018, Riant 1986), although its molecular weight could limit transfer to milk (Briggs 2017 p157-158).
Some authors suggest that bisoprolol is a second option for mothers who breastfeed with postpartum cardiomyopathy when metoprolol succinate is not available (Kearney 2018); others mention a change from metoprolol to bisoprolol in some patients (Barasa 2018).
The use of bisoprolol is considered likely to be compatible during breastfeeding by some experts (Hale 2019 p77-78, Malachias 2016), but until there is more published information on this drug in relation to breastfeeding, safer known alternatives may be preferable, especially during the neonatal period and in case of prematurity.
Some authors do not consider beta-blockers to be drugs of choice for the treatment of hypertension, unless there is another simultaneous indication, such as migraine or prophylaxis of angina. Caution is needed if bisoprolol is used in mothers of premature babies (Anderson 2018).
The protective role of breastfeeding against maternal hypertension has been proven (Park 2018).
Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
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