Last update Nov. 3, 2018
Very Low Risk
Metoprolol is a cardioselective beta-blocker used in the treatment of hypertension, angina pectoris, cardiac arrhythmias, myocardial infarction, heart failure, hyperthyroidism and in the prophylaxis of migraine. Administered orally or intravenously, in 1 to 4 daily doses.
Although metoprolol is a weak base (pKa 9.7) with low plasma protein binding and moderate liposolubility and therefore the milk/plasma index is generally high (Ryu 2016, Kulas 1984, Lindeberg 1984, Liedholm 1981, Sandstorm 1983 and 1980), maternal plasma levels are very low so it is excreted in breastmilk in clinically insignificant amounts (Hale 2019, p 505, Ryu 2016, AEMPS 2016, Astra 2014, Yep 2011, Kulas 1984, Lindeberg 1984, Sandstorm 1983, 1980 and 1978).
The concentration of metoprolol in infant plasma is undetectable or very low and unlikely to be clinically significant for babies (Grundmann 2011, Kulas 1984, Lindeberg 1984, Sandstrom 1983).
No side effects have been observed in infants whose mothers were taking metoprolol (Briggs 2017).
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 needed if metoprolol is used in mothers of premature babies (Anderson 2018).
Several medical associations, experts and expert consensus believe its use to be safe or probably safe during breastfeeding (Alexander 2017, Malachias 2016, Serrano 2014, Davanzo 2014, Rowe 2013, Pringsheim 2012, Ghanem 2008, Tan 2001, Shannon 2000). The American Academy of Pediatrics considers it to be generally compatible with breastfeeding (AAP 2001).
The protective role of breastfeeding against maternal hypertension has been proven (Park 2018).
Suggestions made at e-lactancia are done by APILAM team, 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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