Hypertension during breastfeeding
BP ≥140/90 in a breastfeeding woman. Per ACOG 2020 and SEGO 2023, drugs of choice with best breastfeeding profile: enalapril (RID 0.2%), captopril (RID 0.02%), methyldopa, labetalol, nifedipine. Avoid atenolol (RID 6–19%, infant cyanosis and bradycardia reported) and high-dose diuretics (reduce milk supply). Postpartum, many women with gestational hypertension return to normal in 6–12 weeks.
ICD-10 I106 drugs
Also known as: Postpartum hypertension
Drugs used for this condition
- ALabetalolFirst line · Alpha- and beta-blockerHypertension during breastfeeding. ACOG 2020 and SEGO 2023 – drug of choice. RID 0.2–0.6%, no milk-supply effect. Advantages over methyldopa: no maternal sedation or depression. No clinically significant bradycardia reported in breastfed infants.
- AMethyldopaFirst line · Centrally-acting antiadrenergic agentHypertension during breastfeeding. WHO MEC 2015 and ACOG 2020 – drug of choice. RID 0.2–0.34%, no effect on milk supply. Side effect – maternal sedation, occasional postpartum depressive episodes, so for chronic need consider switching to labetalol or enalapril.
- ANifedipineFirst line · Dihydropyridine calcium channel blockerHypertension during breastfeeding. ACOG 2020 and SEGO 2023 – drug of choice. RID 1.8–3.5%, no milk-supply effect. Also used for nipple vasospasm (Raynaud's of the nipple) in nursing mothers – 30 mg 1–2 times daily.
- BAmlodipineSecond line · Calcium channel blockers (dihydropyridines)After delivery amlodipine is compatible with breastfeeding: 3–7% of the maternal dose passes into milk, at most 15% (Naito 2015, the same figures as in section 4.6 of the AEMPS label), no adverse reactions in infants have been described, and e-lactancia rates it as low risk. NICE NG133 recommends enalapril after birth, and nifedipine or amlodipine for women of African or Caribbean family origin; if one drug is not enough, they are combined. The AEMPS label asks to weigh the benefit of breastfeeding against the benefit of treatment for the mother. Amlodipine is a second choice here after enalapril and nifedipine, which have more lactation data.
- BHydralazineThird line · Direct arteriolar vasodilatorHydralazine during breastfeeding. RID 1.2%, Hale L2. Acceptable but not first-line due to maternal reflex tachycardia and lupus-like syndrome risk with chronic use. Prefer enalapril, methyldopa, labetalol.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit