Bisoprolol fumarate

Bisoprolol fumarate is a cardioselective beta-blocker administered orally once daily in the treatment of hypertension and angina pectoris, in patients with chronic stable heart failure and in the secondary prevention of myocardial infarction. ^{(AEMPS 2015, FDA 2007)}

In a published case of a woman started on bisoprolol at 6 days postpartum, bisoprolol levels were undetectable (<1 mcg / L) in all milk samples 11-18 days after initiation. ^{(Khurana 2014)}

No problems have been observed in infants whose mothers were taking it ^{(Duke 2019)}. Two of 11 infants whose mothers were taking Bisoprolol had drowsiness and one had poor weight gain. None had developmental problems. ^{(De Haan 2023, cited by LactMed)}

The pharmacokinetic characteristics of bisoprolol: low percentage binding to plasma proteins ^{(AEMPS 2015, FDA 2007, Leopold 1986)}, moderate liposolubility, long half-life and relatively high renal excretion ^{(FDA 2007)} make bisoprolol less favorable for nursing mothers. compared to other beta-blockers ^{(Kearney 2018, Riant 1986)}, although its molecular weight could limit passage into milk. ^{(Briggs 2017 p157-158)}

Some authors suggest that bisoprolol is a second option for breastfeeding mothers with postpartum cardiomyopathy when metoprolol succinate is not available ^{(Kearney 2018)}; others mention a switch from metoprolol to bisoprolol in some patients. ^{(Barasa 2018)}

The use of bisoprolol is probably considered compatible during breastfeeding by some experts ^{(Hale, Malachias 2016)}, but until more published data on this drug in relation to breastfeeding are known safer 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 concurrent indication, such as migraine or angina prophylaxis. Caution is needed if bisoprolol is used in mothers of premature infants. ^{(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 substance and/or breastfeeding is the best option.)