There actually is some information about these drugs.

Lisinopril has the disadvantage of having a long half life and low protein
binding.  However, its oral bioavailability is better.

Ramipril has a long half life and relatively low protein binding.  Its oral
availability is greater than lisinopril's, so of the two lisinopril would
*theoretically* be better.

Losartan has a shorter half life, high protein binding and low oral
availability.  It sounds the best of these possibilities, but has not been
around for a long time.

So.  Why these three drugs?  Why not captopril an ace inhibitor we have used
for years in young babies?

So. Why an ace inhibitor?  What is the condition being treated?  Maybe other
alternatives are available, since newborns are sensitive to ace inhibitors.

I would go with captopril or losartan.  And if, for some reason, one of the
other drugs is necessary, continue breastfeeding and watch.  Maternal blood
levels, milk levels and baby blood levels could be monitored so that next
year or the year after Dr. Hale could write that *some* information is
available.

Jack Newman, MD, FRCPC