Last update: Jan. 15, 2019
Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
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Carvedilol is a non-cardioselective beta-blocker, which is administered orally once or twice a day.
It is used in the treatment of hypertension and angina pectoris, but also as an adjunct to standard therapy in mild or moderate symptomatic heart failure of ischemic or cardiomyopathic origin and in patients with left ventricular dysfunction after a myocardial infarction ( Zentiva 2013, FDA 2005).
Since the last update we have not found published data on its excretion in breastmilk.
The pharmacokinetic characteristics of carvedilol (high percentage of binding to plasma proteins (Tamargo 2011, Kirsten 1998, Riant 1986) and moderately short half-life) make the excretion of carvedilol in significant quantities very unlikely (Kearney 2018, Riant 1986), but its low molecular weight and high liposolubility (Kirsten 1998) could facilitate possible transfer (Kearney 2018).
Its low oral bioavailability complicates transfer to infant plasma from breastmilk, except in premature babies and the immediate neonatal period when there may be increased intestinal permeability.
The American Academy of Pediatrics considers other beta-blockers from the same family and similar chemical structure (Labetalol, Propranolol) to be usually compatible with breastfeeding (AAP 2001).
Several experts believe that the use of this medication is safe or probably safe during breastfeeding (Hale 2019 p 121, Briggs 2017, Malachias 2016).
Some authors suggest that carvedilol is a second option for mothers who breastfeed with postpartum cardiomyopathy when metoprolol succinate is not available (Kearney 2018) and others mention a change from metoprolol to carvedilol in some patients (Barasa 2018).
Until there is more published data 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 necessary if metoprolol 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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