Last update: Jan. 15, 2019

Carvedilol

Low Risk for breastfeeding


Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
Read the Comment.

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).


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Alternatives

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

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Other names

Carvedilol is also known as


Carvedilol in other languages or writings:

Group

Carvedilol belongs to this group or family:

Tradenames

Main tradenames from several countries containing Carvedilol in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 25 - 35 %
Molecular weight 407 daltons
Protein Binding > 98 %
VD 1,64 l/Kg
pKa 14,03 -
Tmax 1 - 2 hours
T1/2 6 - 11 hours

References

  1. Park S, Choi NK. Breastfeeding and Maternal Hypertension. Am J Hypertens. 2018 Abstract
  2. Anderson PO. Treating Hypertension During Breastfeeding. Breastfeed Med. 2018 Abstract
  3. Barasa A, Goloskokova V, Ladfors L, Patel H, Schaufelberger M. Symptomatic recovery and pharmacological management in a clinical cohort with peripartum cardiomyopathy. J Matern Fetal Neonatal Med. 2018 Abstract
  4. Kearney L, Wright P, Fhadil S, Thomas M. Postpartum Cardiomyopathy and Considerations for Breastfeeding. Card Fail Rev. 2018 Abstract Full text (link to original source) Full text (in our servers)
  5. Malachias MV, Figueiredo CE, Sass N, Antonello IC, Torloni MR, Bortolotto MRF L. 7th Brazilian Guideline of Arterial Hypertension: Chapter 9 - Arterial Hypertension in pregnancy Arq Bras Cardiol. 2016 Abstract Full text (link to original source) Full text (in our servers)
  6. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. Tenth edition (acces on line) 2015
  7. Zentiva Carvedilol. Ficha técnica. 2013 Full text (in our servers)
  8. Tamargo Menéndez J, Delpón Mosquera E. Farmacología de los bloqueantes de los receptores β-adrenérgicos. Curso βeta 2011 de Actualización en Betabloqueantes. 2011 Full text (in our servers)
  9. FDA-GSK. Carvedilol (Coreg). Drug Summary. 2005 Full text (in our servers)
  10. American Academy of Pediatrics Committee on Drugs.. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Abstract
  11. Kirsten R, Nelson K, Kirsten D, Heintz B. Clinical pharmacokinetics of vasodilators. Part II. Clin Pharmacokinet. 1998 Abstract
  12. Riant P, Urien S, Albengres E, Duche JC, Tillement JP. High plasma protein binding as a parameter in the selection of betablockers for lactating women. Biochem Pharmacol. 1986 Abstract
  13. Hale TW. Hale's Medications & Mothers' Milk. [Internet]. Springer Publishing Company; 1991-. Available from: https://www.halesmeds.com None

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