To  Luann Smith...Re: Calcium channel blockers

        The CCB's are really under pressure now,  particularly since the
data seems to suggest that they increase morbidity/mortality in hypertensive
patients(this story is yet to be proven).  The whole story is that they are
very useful in some patients(particularly elderly) who do not do so well on
beta blocker antihypertensives.

Nevertheless,  neither verapamil or nifedipine attain very high levels in
breast milk,  probably somewhere less than 0.01%(verapamil) to <
5%(nifedipine) of the maternal dose is transferred daily to the infant.
Because both of these products have relatively short half-lives,  they are
administered in prolonged release formulations,   which does away with
trying to breastfeed around the peak level.   The verapamil was not
detectible in milk.     However,   if used in moderation,  and if the
infants' blood pressure were occassionally monitored the first few weeks of
therapy,  these agents can be used safely by breastfeeding moms.   Just
watch the infant for hypotension and bradycardia.

One important note however,  CCBs in overdose are incredibly dangerous.
Several deaths have been reported by as few  as   1-3  tablets in infants.
Please keep these formulations out of the reach of children and use
child-protective caps.     Check your granny's house as well.   Treatment
of CCB overdose is almost impossible,  and often fails.  Lets be careful.

To all those interested, I'll be unable to answer questions this next week,
I'll be gone to the Toxicology Meetings in Rochester until the 20th. twh

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T.W. Hale, Ph.D.
Associate Professor of Pediatrics
Texas Tech University School of Medicine

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