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Isosorbide dinitrate is a vasodilator used in the treatment of angina pectoris and heart failure. It has general properties similar to those of glyceryl trinitrate or nitroglycerin. Its active metabolite is isosorbide mononitrate. Sublingual, oral, transdermal or intravenous administration.
At the time of the last update, we found no published data on its excretion in breast milk.
Its pharmacokinetic data (large volume of distribution and short half-life) (Kirsten 1998) make it unlikely to pass into breast milk in clinically significant quantities.
Its low oral bioavailability makes it difficult to pass into infant plasma from ingested breast milk, except in premature infants and the immediate neonatal period where there may be greater intestinal permeability.
If used during breastfeeding, it is advisable to monitor the infant for symptoms of drowsiness, lethargy or poor feeding and to monitor for weight gain. (Kearney 2018)
The amount of nitrate/nitrite in breast milk is not related to the level of nitrate ingested by the mother in water, food or medications (Paszkowski 1989). Ingestion of up to 100 mg/day of nitrate does not increase nitrate levels in breast milk. (Dusdieker 1996). For this reason, breastfed infants from regions with nitrate-contaminated water do not have an increased risk of methemoglobinemia, in contrast to bottle-fed infants.
The amount of nitrate compounds contained in vasodilator drugs is so small that no nitrate toxicity problems, such as methemoglobinemia, have been reported in breastfed infants whose mothers used them.