Last update: Oct. 31, 2018

Captopril

Very Low Risk for breastfeeding


Safe. Compatible.
Not risky for breastfeeding or infant.

Captopril is an angiotensin-converting enzyme (ACE) inhibitor used in the treatment of hypertension, heart failure, myocardial infarction and type 1 diabetic nephropathy.
Oral administration every 8-12-24 hours.

It is excreted in breastmilk in clinically insignificant amounts (Anderson 2018, FT 2018, Serrano 2015, Drummer 1986, Devlin 1981) and no problems have been observed in infants whose mothers were taking it (Anderson 2018, Devlin 1981).

Due to its possible renal toxicity in preterm infants, it is preferable to avoid its use during the neonatal period in mothers of premature infants (Serrano 2015).

There are conflicting reports about the effect of captopril on the secretion of prolactin (Saito 1990, Denolle 1990, Anderson 1989). However, when breastfeeding is well established, milk production does not depend on prolactin levels.

Expert authors and medical associations such as the American Academy of Pediatrics consider it to be usually compatible with breastfeeding (Serrano 2015, Rowe 2013, Dennis 2012, Ghanem 2008, AAP 2001, Kirsten 1998).
List of essential medicines WHO: compatible with breastfeeding (WHO/UNICEF, 2002).

Alternatives

We do not have alternatives for Captopril since it is relatively safe.

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Captopril in other languages or writings:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 60 - 75 %
Molecular weight 217 daltons
Protein Binding 25 - 30 %
VD 0,7 l/Kg
pKa 3,7 - 4,02 -
Tmax 1 - 1,5 hours
T1/2 2 hours
M/P ratio 0,006 - 0,01 -
Theoretical Dose 0,0007 mg/Kg/d
Relative Dose 0,03 %
Relat.Ped.Dose 0,03 %

References

  1. Anderson PO. Treating Hypertension During Breastfeeding. Breastfeed Med. 2018 Abstract
  2. AEMPS. Captopril. Ficha técnica. 2017 Full text (in our servers)
  3. Malachias MV, Figueiredo CE, Sass N, Antonello IC, Torloni MR, Bortolotto MRF L. 7th Brazilian Guideline of Arterial Hypertension: Chapter 9 - Arterial Hypertension in pregnancy Arq Bras Cardiol. 2016 Abstract Full text (link to original source) Full text (in our servers)
  4. Serrano Aguayo P, García de Quirós Muñoz JM, Bretón Lesmes I, Cózar León MV. Tratamiento de enfermedades endocrinológicas durante la lactancia. [Endocrinologic diseases management during breastfeeding.] Med Clin (Barc). 2015 Abstract
  5. FDA. Captopril. Drug Summary. 2014 Full text (in our servers)
  6. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  7. Dennis AT. Management of pre-eclampsia: issues for anaesthetists. Anaesthesia. 2012 Sep;67(9):1009-20. Abstract Full text (link to original source) Full text (in our servers)
  8. Ghanem FA, Movahed A. Use of antihypertensive drugs during pregnancy and lactation. Cardiovasc Ther. 2008 Abstract Full text (link to original source) Full text (in our servers)
  9. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  10. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Abstract Full text (link to original source) Full text (in our servers)
  11. Kirsten R, Nelson K, Kirsten D, Heintz B. Clinical pharmacokinetics of vasodilators. Part II. Clin Pharmacokinet. 1998 Abstract
  12. Saito I, Takeshita E, Hayashi S, Takenaka T, Murakami M, Saruta T, Nagano S, Sekihara T. Effect of captopril on plasma prolactin in patients with essential hypertension. Angiology. 1990 Abstract
  13. Denolle T, Rohmer V, Saint-Adnré JP, Guyene TT, Galland F, Bigorgne JC, Schambelan M, Corvol P. Effect of the circulating renin-angiotensin system on prolactin release in humans. J Clin Endocrinol Metab. 1990 Abstract
  14. Anderson PW, Malarkey WB, Salk J, Kletsky OA, Hsueh WA. The effect of angiotensin-converting enzyme inhibition on prolactin responses in normal and hyperprolactinemic subjects. J Clin Endocrinol Metab. 1989 Abstract
  15. Duchin KL, McKinstry DN, Cohen AI, Migdalof BH. Pharmacokinetics of captopril in healthy subjects and in patients with cardiovascular diseases. Clin Pharmacokinet. 1988 Abstract
  16. Drummer OH, Jarrott B. The disposition and metabolism of captopril. Med Res Rev. 1986 Abstract
  17. Devlin RG, Fleiss PM. Captopril in human blood and breast milk. J Clin Pharmacol. 1981 Abstract

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