Acebutolol

Acebutolol is a cardio-selective beta-blocker, used in the treatment of hypertension, angina pectoris and cardiac arrhythmias. It is administered orally once or twice daily and by slow intravenous injection for emergency treatment of arrhythmias. Acebutolol is used in neonates and young infants (treatment of subglottic and infantile hemangiomas) at doses of 8 mg/kg/day. ^{(Frieden 2011, Blanchet 2010)}

Acebutolol and its active metabolite, diacetolol, are excreted in breast milk in small, possibly non-significant concentration. ^{(FDA 2007, Abolfazl 2003, Atkinson 1988, Boutroy 1986, Bianchetti 1981)}

Symptoms of β-blockade (hypotension, bradycardia, and transient tachypnea) were observed in one infant, although he was already exposed to acebutolol in utero ^{(Boutroy 1986)} and infants exposed to acebutolol intrauterinally may show alterations in heart rhythm at birth, blood pressure and blood glucose levels, regardless of their exposure to acebutolol through breast milk ^{(Boutroy 1986 and 1982, Dumez 1981)}, and treatment should be discontinued 8 to 12 hours before birth ^{(Morselli 1989)}. Two other newborns and one infant had no clinical problems. ^{(Ho 1999, Boutroy 1986)}

The pharmacokinetic characteristics of acebutolol, such as low percentage binding to plasma proteins ^{(FDA 2007, Riant 1986, Bianchetti 1981)}, low lipid solubility, longer half-life of the active metabolite diacetolol ^{(FDA 2007)} and mainly renal excretion ^{(Schaefer 2007 p 689)} make acebutolol less favorable for nursing mothers, compared to other beta-blockers, especially in mothers who are breastfeeding a newborn or premature infant, so safer known alternatives may be preferable, especially during the neonatal period and in case of prematurity. ^{(Kearney 2018, Anderson 2018, Rowe 2013, Ghanem 2008, Schaefer 2007, Chow 1998, Riant 1986)}

The American Academy of Pediatrics considers that acebutolol should be administered with caution to breastfeeding mothers ^{(AAP 2001)}. Some authors do not consider beta blockers to be the drugs of choice for the treatment of hypertension unless there is another concurrent indication, such as migraine or prophylaxis with angina pectoris. ^{(Anderson 2018)} 

The protective role of breastfeeding against maternal hypertension has been demonstrated. ^{(Park 2018)}

See below the information of this related product:

• Maternal High blood pressure, HBP (hypertension, HTN) (Safe product and/or breastfeeding is the best option.)