Nifedipine use while Breastfeeding

Drugs containing Nifedipine: Procardia, Adalat, Nifedical XL, Procardia XL, Nifediac CC, Afeditab CR, Adalat CC, Adalat XL Plus

Nifedipine Levels and Effects while Breastfeeding

Summary of Use during Lactation

Because of the low levels of nifedipine in breastmilk, amounts ingested by the infant are small and no adverse effects have been reported among a limited number of infants exposed to nifedipine in breastmilk. Nifedipine has been used to treat painful nipple vasospasm (e.g., Raynaud phenomenon) in nursing mothers.

Drug Levels

Maternal Levels. A woman taking nifedipine 10 mg four times daily was given a 20 mg test dose 10 days postpartum. One hour after this dose, peak milk levels of the drug and its pyridine metabolite were 43 and 15 mcg/L, respectively. By 4 hours after the dose, the levels of both drugs in breastmilk were less than 5 mcg/L.[1]

Another woman taking a doses of 10, 20 and 30 mg every 8 hours on different days shortly after delivering a premature infant had peak milk levels 1 hour after each dose. The half-life of the drug in milk varied with dosage: 1.4 hours with the 10 mg dose; 3.1 hours with the 20 mg dose; and 2.4 hours with the 30 mg dose. The average milk half-life of all doses was 3.3 hours. The highest milk level found was 53 mcg/L at 30 minutes after the 30 mg dose. Nifedipine had fallen to undetectable levels (<2 mcg/L) by 5.25 hours after the 10 mg dose. At 8 hours after the dose, nifedipine concentrations in milk were 3.2 mcg/L with the 20 mg dose and 4.9 mcg/L with the 30 mg dose. The total amounts in milk collected over 24 hours were 0.12 mcg with 10 mg every 8 hours, an average of 1.07 mcg with 20 mg every 8 hours, and an average of 1.71 mcg with 30 mg every 8 hours. Using the peak milk level data from the 30 mg every 8 hour dosage in this study, the authors estimated that an exclusively breastfed infant would receive an estimated maximum of 7.5 mcg/kg daily with this maternal dosage regimen.[2]

In 6 women taking a dose of 10 mg three times daily, milk levels ranged from <1 to 10.3 mcg/L at random times between 1 and 8 hours after a dose, with a median of 3.5 mcg/L.[3]

In a study of 21 women taking a median dosage of 40 mg daily, mostly as a sustained-release product, 13 donated milk samples at a median of 7 days postpartum (range 1 to 100 days). The infants would receive an average daily dosage of 0.1% of their mother's weight-adjusted dosage in breastmilk.[4]

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

No adverse reactions have been reported among infants exposed to nifedipine in breastmilk mostly at maternal dosages of 30 mg daily beginning shortly postpartum and continuing for up to 6 months in some.[1][4][5][6][7][8][9][10]

Possible Effects on Lactation

No direct effects are known. However, nifedipine has been used to decrease the pain of nipple vasospasm (or Raynaud phenomenon of the nipple), allowing mothers to continue nursing who might otherwise discontinue breastfeeding. The dosage of nifedipine reportedly used to treat the condition is 30 to 60 mg daily either as a single dose of a sustained-release product or 10 mg 3 times daily of an immediate-release product. Lower dosages can be tried if these doses are not tolerated.[5][6][7][8][11]

Nifedipine had no effect on milk composition (sodium, potassium, calcium, chloride, nitrogen, phosphorus and total lipids) in one woman.[2]

Alternate Drugs to Consider

Nitrendipine

References

1. Penny WJ, Lewis MJ. Nifedipine is excreted in human milk. Eur J Clin Pharmacol. 1989;36(4):427-8. PMID: 2737237

2. Ehrenkranz RA , Ackerman BA, Hulse JD. Nifedipine transfer into human milk. J Pediatr. 1989;114(3):478-80. PMID: 2921695

3. Manninen AK, Juhakoski A. Nifedipine concentrations in maternal and umbilical serum, amniotic flud, breast milk and urine of mothers and offspring. Int J Clin Pharm Res. 1991;11:231-6. PMID: 1814844

4. Taddio A, Oskamp M, Ito S et al. Is nifedipine use during labour and breast-feeding safe for the neonate? Clin Invest Med. 1996;19(4 Suppl):S11. Abstract.

5. Lawlor-Smith LS, Lawlor-Smith CL. Raynaud's phenomenon of the nipple: a preventable cause of breastfeeding failure? Med J Aust. 1996;166:448. Letter. PMID: 9140358

6. Garrison CP. Nipple vasospasm, Raynaud's syndrome, and nifedipine. J Hum Lact. 2002;18(4):382-5. PMID: 12449056

7. Anderson JE, Held N, Wright K. Raynaud's phenomenon of the nipple: a treatable cause of painful breastfeeding. Pediatrics. 2004;113(4):e360-4. PMID: 15060268

8. Page SM, McKenna DS. Vasospasm of the nipple presenting as painful lactation. Obstet Gynecol. 2006;108 (3 part 2):806-8. PMID: 17018510

9. O'Sullivan S, Keith MP. Raynaud phenomenon of the nipple: a rare finding in rheumatology clinic. J Clin Rheumatol. 2011;17:371-2. PMID: 21946463

10. Wu M, Chason R, Wong M. Raynaud's phenomenon of the nipple. Obstet Gynecol. 2012;119 (2 Pt 2):447-9. PMID: 22270434

11. Barrett ME , Heller MM, Fullerton Stone H, Murase JE. Raynaud phenomenon of the nipple in breastfeeding mothers: An underdiagnosed cause of nipple pain. JAMA Dermatology. 2013;149:300-6. PMID: 23247299

Nifedipine Identification

Substance Name

Nifedipine

CAS Registry Number

21829-25-4

Drug Class

  • Antihypertensive Agents
  • Calcium Channel Blockers
  • Vasodilator Agents

Administrative Information

LactMed Record Number

198

Information from the National Library of Medicine's LactMed Database.

Last Revision Date

2013-09-07

Disclaimer

Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

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