Is Perindopril safe while breastfeeding?
Here is what LactMed, the Drugs and Lactation Database published by the U.S. National Institute of Child Health and Human Development (NICHD), reports about Perindopril. The text below is quoted from that source — it is not our own verdict.
Summary of use during breastfeeding
Limited information indicates that only low levels of perindopril and its active metabolite are found in breastmilk, which is consistent with other drugs in this class. Amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants.
Effects on the breastfed infant
Ten infants were breastfed (extent not stated) by mothers were taking perindopril 5 to 20 mg daily. All infants grew and developed normally according to their parents.[2]
Effects on milk supply
Relevant published information was not found as of the revision date.
Levels in milk
Maternal Levels. A breast feeding mother who was taking perindopril erbumine 10 mg twice daily for 2 weeks donated one breastmilk sample 9 hours after a dose. The sample contained 0.9 mcg/L of perindopril and 22.5 mcg/L of perindoprilat in breastmilk.[1]
Ten women taking perindopril donated a total of 79 milk samples. The exact timing of samples was not given. Dosages ranged from 5 to 20 mg daily. In the women taking 5 mg daily (n = 3), the average milk perindopril concentration was 0.32 mcg/L. In the women taking 10 mg daily (n = 6), the average milk perindopril concentration was 0.57 mcg/L. In the woman taking 20 mg daily (n = 1), the average milk perindopril concentration was 1.03 mcg/L. For the metabolite, perindoprilat, the 5 mg dose yielded an average milk concentration of 10.35 mcg/L, the 10 mg dose yielded an average of 9.25 mcg/L, and the 20 mg dose 0.42 mcg/L. The weight-adjusted infant dosage ranges were 0.0005 to 0.2% for perindopril and 0.03 to 4.6% for perindoprilat.[2]
Infant Levels. Three infants were breastfed (extent not stated) by mothers taking perindopril. One infant whose mother was taking 5 mg daily had serum levels of 1.12 mcg/L of perindopril and 10.14 mcg/L of perindoprilat. In two infants whose mothers were taking 10 mg daily, average perindopril level was 0.78 mcg/L and perindoprilat was 2.64 mcg/L.[2]
Alternatives LactMed lists
Perindopril in pregnancy
LactMed covers breastfeeding only. For what the NHS and the US prescribing label say about pregnancy, see:
Source: Drugs and Lactation Database (LactMed), National Institute of Child Health and Human Development (NICHD), via NCBI Bookshelf, record “Perindopril” (LM211). LactMed on NCBI Bookshelf. LactMed is a registered trademark of the U.S. Department of Health and Human Services.
Educational summary of an authoritative source — not medical advice. Never start, stop, or change a medicine while breastfeeding without confirming with your doctor.