Last update July 30, 2022
Very Low Risk
Propranolol is a non-cardioselective beta blocker that is usually given orally or intravenously, once or twice a day. It is used in the treatment of hypertension, pheochromocytoma, angina pectoris, myocardial infarction, cardiac arrhythmias, hypertrophic cardiomyopathy, to control the symptoms of hyperthyroidism, anxiety disorders and tremor. Other indications include the prophylaxis of migraine and upper gastrointestinal bleeding in patients with portal hypertension (FDA 2013, AEMPS 2012). Propranolol is also used in infants with tetralogy of Fallot and to treat infantile hemangiomas. (Hagen 2018)
The pharmacokinetic characteristics of propranolol, especially its high percentage of plasma protein binding (Riant 1986), explain the negligible excretion observed in milk, much lower than the dose used for newborns and babies. (Anderson 2018, Atkinson 1988, Livingstone 1983, Smith 1983, Thorley 1983, Taylor 1981, Lewis 1981, Bauer 1979, Anderson 1976, Karlberg 1974, Levitan 1973)
Propranolol has been used successfully in cases of persistent breast pain during breastfeeding.(Muddana 2018)
A case of drowsiness has been described in an infant whose mother was taking propranolol and other medications (Ho 1999). A 2-day-old newborn girl had bradycardia; but it is possible that the mother had taken propranolol shortly before delivery. (Soussan 2014)
Monitoring of the infant is advised if propranolol is used in mothers of infants with asthma. (Hale).
Some authors do not consider that beta-blockers are drugs of choice for the treatment of hypertension, unless there is another simultaneous indication, such as migraine or prophylaxis of angina. (Anderson 2018)
Several medical associations, experts and expert consensus consider its use to be safe or probably safe during breastfeeding. (Hale, Alexander 2017, Malachias 2016, Serrano 2014, Davanzo 2014, Rowe 2013, Pringsheim 2012, Ghanem 2008, Mahadevan 2006, OMS 2002, AAP 2001, Tan 2001, Shannon 2000, Taylor 1981, Lewis 1981)
The protective role of breastfeeding against maternal hypertension has been proven. (Park 2018)
We do not have alternatives for Propranolol since it is relatively safe.
Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.
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e-lactancia is a resource recommended by Academy of Breastfeeding Medicine - 2012 of United States of America
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