Beta-blockers vary considerably in their extent of passage into breastmilk and in their propensity to accumulate in the infant’s serum. Adverse effects have been reported in breastfed infants with some beta-blockers. Avoiding the use of water-soluble drugs, which pass into milk in greater amounts, and those with long half-lives decreases the risk of adverse effects in breastfed infants. Atenolol and acebutolol are best avoided while breastfeeding neonates because of reported adverse effects. Sotalol has similar characteristics and should be used with caution. Beta-blockers that are the least likely to cause problems during breastfeeding are labetalol, metoprolol and propranolol. For information on specific drugs, refer to LactMed: https://www.ncbi.nlm.nih.gov/books/NBK501922/
- Boutroy MJ, Bianchetti G, Dubruc C et al. To nurse when receiving acebutolol: is it dangerous for the neonate? Eur J Clin Pharmacol. 1986;30:737-9.
- Schimmel MS, Eidelman AI, Wilschanski MA et al. Toxic effects of atenolol consumed during breast feeding. J Pediatr. 1989;114:476-8.