On 29 Nov 2000, at 10:16, Denise Fisher wrote:

> Could someone please give me information on Perindopril during
> lactation? I found no matches in the archives.
>
> The story:
> Lovely woman sectioned at 34K for ?severe PIH - twin pregnancy (IVF).
> This lady (primip) is devoted to breastfeeding - had been expressing
> from before the c/s (as soon as she found out it was to happen) and
> was very keen to avoid all artificial formula.
>
> Mother was unwell and had various tests which excluded pulmonary
> embolus and other conditions.  Returned to theatre for evacuation of a
> haematoma in her rectus sheath, then was finally diagnosed with
> cardiomyopathy.  She was cared for in intensive care, expressing
> continued, however she was commenced on perindopril which the
> cardiologist said was contraindicated during lactation.  She was told
> she'd be on it for 6 months and she elected to continue to express for
> the next 6 months and to resume breastfeeding after that period.
> Anyway the time has been reduced to two months as there is improvement
> in her condition (grade 1 apparently - I'm a midwife/LC, have no idea
> what that means!).
>
> I've been tasked with finding out more about this drug.  I haven't met
> the cardiologist, however reportedly he is a very approachable man who
> would also like to know more about this drug in lactation. The mother
> just wants to get off it as quickly as possible so she can resume
> breastfeeding her babies.

I am not a medical professional, just a LLL Leader and breastfeeding
busybody, but I do like to do research on medications for some strange
reason.  I did a quick scan of the message board on Dr. Hale's website
(which is a fantastic resource that everyone should bookmark)
<http://neonatal.ttuhsc.edu>

The search revealed no messages about perindopril, but I found out from
RxList <http://www.rxlist.com> that it is an ACE inhibitor.  So I searched on
ACE inhibitor and found that Dr. Hale says that there is good data on the
breastmilk concentrations of three ACE inhibitors: Enalapril, Captopril, and
Benazepril, and they are all low.  I then looked those three up in my
Breastfeeding Answer Book, which has a reprint of the American
Academy of Pediatrics' 1994 publication on medications in mothers' milk
and found that Enalapril and Captopril are on the list of meds that are
"usually compatible with breastfeeding."  Since the AAP tends to be overly
cautious if anything, I'd be pretty confident in suggesting that, unless there
is some demonstrated need to use the latest ACE inhibitor, she be
allowed to try one of the two medications in that class that are more
suitable for a nursing mom.

A cautionary note, however: Dr. Hale mentions in a few of his posts that he
would prefer to wait until an infant is two to four weeks old before exposing
them to any amount of ACE inhibitor, because of the risk of lowering the
baby's blood pressure.  And I haven't a clue whether that would need to be
a corrected age for 6-week premies like the twins.  On the other hand, if
the babies are still in the hospital and have their blood pressure constantly
monitored, I'd wager that the risk to them is very low.

Rachael Hamlet
Boobologist Extraordinaire

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