Is Enalapril safe while breastfeeding?
Here is what NIH LactMed, the U.S. National Library of Medicine's authority on medicines and breastfeeding, reports about Enalapril. This is a summary of that source — not our own verdict.
Effects on the breastfed infant
None reported in 5 breastfed infants whose mothers were taking oral enalapril 5 to 10 mg daily.[ 1 , 2 , 4 ]
Effects on milk supply
In 15 postmenopausal hypertensive women (prior lactation status not stated), serum prolactin levels were decreased by 22% compared to placebo after enalapril 20 mg once daily for 15 days.[ 5 ] The maternal prolactin level in a mother with established lactation may not affect her ability to breastfeed. A woman with pre-eclampsia was treated was started at term with oral enalapril 10 mg daily. Her milk came in on day 3 postpartum and she had no difficulties with nursing during 5 weeks of observation.[ 6 ]
Levels in milk
Enalapril is an inactive drug that is metabolized to the active metabolite enalaprilat. Enalaprilat is poorly absorbed orally. Maternal Levels. One mother taking a single oral dose of enalapril 5 mg and 2 mothers taking a single dose 10 mg 3 to 45 days postpartum had undetectable enalaprilat milk levels ( 0.2 mcg/L) 4 hours after a single dose; enalapril levels were not determined. The angiotensin converting enzyme activity in milk of all women was within the normal range and unchanged after the dose compared to the predose values.[ 1 ] A woman who had been taking oral enalapril 10 mg daily for 11 months had peak enalapril milk levels of 2 mcg/L 4 hours after a dose and peak enalaprilat levels of 0.75 mcg/L about 9 hours after the dose.[ 2 ] Enalapril and enalaprilat milk levels were determined in 5 women who were in the immediate postpartum period and not breastfeeding. After a single 20 mg oral dose, the average peak enalapril milk level was 1.7 mcg/L (range 0.54 to 5.9 mcg/L) at 4 to 6 hours after the dose. Enalapril was not detectable (assay limit not specified) after 4 hours in 4 of the 5 women. The average peak enalaprilat level was 1.7 mcg/L (range 1.2 to 2.3 mcg/L); peaks occurred at various times over the 24-hour period. The authors estimated that a breastfed infant would receive less than 2 mcg daily of enalaprilat.[ 3 ] Using the peak milk level data, the estimated maximum intake of an exclusively breastfed infant would be about 0.16% of the maternal weight-adjusted dosage, half as enalaprilat. A mother started taking enalapril 5 mg daily for IgA nephropathy at 11 weeks postpartum while exclusively breastfeeding. On day 101 postpartum, 25 days after therapy started, 6 milk samples were collected over the 24 hours after the dose. The estimated RID of enalapril plus enalaprilat was 0.196%.[ 4 ] Infant Levels. A mother started taking enalapril 5 mg daily for IgA nephropathy at 11 weeks postpartum while exclusively breastfeeding. On day 101 postpartum, 25 day
Alternatives LactMed lists
Source: NIH LactMed (National Library of Medicine).
Educational summary of an authoritative source — not medical advice. Never start, stop, or change a medicine while breastfeeding without confirming with your doctor.