Last update April 15, 2024

beta-Propranolol

Compatible

Safe substance and/or breastfeeding is the best option.

Propranolol is a non-cardioselective beta blocker that is usually given orally or intravenously, once or twice a day. It is used in the treatment of hypertension, pheochromocytoma, angina pectoris, myocardial infarction, cardiac arrhythmias, hypertrophic cardiomyopathy, to control the symptoms of hyperthyroidism, anxiety disorders and tremor. Other indications include the prophylaxis of migraine and upper gastrointestinal bleeding in patients with portal hypertension (FDA 2013, AEMPS 2012). Propranolol is also used in infants with tetralogy of Fallot and to treat infantile hemangiomas. (Hagen 2018) 

The pharmacokinetic characteristics of propranolol, especially its high percentage of plasma protein binding (Riant 1986), explain the negligible excretion observed in milk, much lower than the dose used for newborns and babies. (Anderson 2018, Atkinson 1988, Livingstone 1983, Smith 1983, Thorley 1983, Taylor 1981, Lewis 1981, Bauer 1979, Anderson 1976, Karlberg 1974, Levitan 1973)

Propranolol has been used successfully in cases of persistent breast pain during breastfeeding.(Muddana 2018)

A case of drowsiness has been described in an infant whose mother was taking propranolol and other medications (Ho 1999). A nursing mother taking Propanolon™ referred to us in 10/2023 drowsiness in her nursing infant, so her physician discontinued treatment (age and type of breastfeeding and dose not referred). 

A 2-day-old newborn girl had bradycardia; but it is possible that the mother had taken propranolol shortly before delivery. (Soussan 2014)

Monitoring of the infant is advised if propranolol is used in mothers of infants with asthma (Hale). Monitor the appearance of somnolence in the infant.

Some authors do not consider that beta-blockers are drugs of choice for the treatment of hypertension, unless there is another simultaneous indication, such as migraine or prophylaxis of angina. (Anderson 2018)

Several medical associations, experts and expert consensus consider its use to be safe or probably safe during breastfeeding. (Hale, Alexander 2017, Malachias 2016, Serrano 2014, Davanzo 2014, Rowe 2013, Pringsheim 2012, Ghanem 2008, Mahadevan 2006, OMS 2002, AAP 2001, Tan 2001, Shannon 2000, Taylor 1981, Lewis 1981)

The protective role of breastfeeding against maternal hypertension has been proven. (Park 2018)

Alternatives

We do not have alternatives for beta-Propranolol since it is relatively safe.

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

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

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Other names

beta-Propranolol is also known as Propranolol. Here it is a list of alternative known names::


beta-Propranolol in other languages or writings:

Groups

beta-Propranolol belongs to these groups or families:

Tradenames

Main tradenames from several countries containing beta-Propranolol in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 25 - 30 %
Molecular weight 259 daltons
Protein Binding 90 %
VD 3 - 5 l/Kg
pKa 9.5 -
Tmax 1 - 4 hours
T½ 3 - 6 hours
M/P ratio 0.05 - 0.5 -
Theoretical Dose 0.002 - 0.02 mg/Kg/d
Relative Dose 0.1 - 0.9 %
Ped.Relat.Dose 0.04 - 0.9 %

References

  1. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on April 10, 2024 Full text (link to original source)
  2. Hagen R, Ghareeb E, Jalali O, Zinn Z. Infantile hemangiomas: what have we learned from propranolol? Curr Opin Pediatr. 2018 Aug;30(4):499-504. Abstract
  3. Muddana A, Asbill DT, Jerath MR, Stuebe AM. Quantitative Sensory Testing, Antihistamines, and Beta-Blockers for Management of Persistent Breast Pain: A Case Series. Breastfeed Med. 2018 May;13(4):275-280. Abstract
  4. Anderson PO. Treating Hypertension During Breastfeeding. Breastfeed Med. 2018 Abstract
  5. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017 Abstract Full text (link to original source) Full text (in our servers)
  6. 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)
  7. 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 Jan 20;144(2):73-9. Abstract
  8. Davanzo R, Bua J, Paloni G, Facchina G. Breastfeeding and migraine drugs. Eur J Clin Pharmacol. 2014 Abstract
  9. Soussan C, Gouraud A, Portolan G, Jean-Pastor MJ, Pecriaux C, Montastruc JL, Damase-Michel C, Lacroix I. Drug-induced adverse reactions via breastfeeding: a descriptive study in the French Pharmacovigilance Database. Eur J Clin Pharmacol. 2014 Abstract
  10. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  11. FDA-Akrimax. Propranolol (Innopran) Drug Summary. 2013 Full text (in our servers)
  12. AEMPS- Astra Zeneca. Propranolol (Sumial). Ficha técnica. 2012 Full text (in our servers)
  13. Pringsheim T, Davenport W, Mackie G, Worthington I, Aubé M, Christie SN, Gladstone J, Becker WJ; Canadian Headache Society Prophylactic Guidelines Development Group. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2012 Abstract Full text (in our servers)
  14. Tamargo Menéndez J, Delpón Mosquera E. Farmacología de los bloqueantes de los receptores β-adrenérgicos. Curso βeta 2011 de Actualización en Betabloqueantes. 2011 Full text (in our servers)
  15. 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)
  16. Mahadevan U, Kane S. American gastroenterological association institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006 Jul;131(1):283-311. Review. Abstract Full text (link to original source) Full text (in our servers)
  17. 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 Abstract Full text (link to original source) Full text (in our servers)
  18. Tan HL, Lie KI. Treatment of tachyarrhythmias during pregnancy and lactation. Eur Heart J. 2001 Abstract Full text (link to original source) Full text (in our servers)
  19. 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)
  20. Ho T, Moretti M, Shaeffer I, Ito S, Koren G. Maternal β-Blocker Usage and Breast Feeding in the Neonate. Pediatr Res. 1999;45:67. Poster 385. Full text (link to original source) Full text (in our servers)
  21. Kirsten R, Nelson K, Kirsten D, Heintz B. Clinical pharmacokinetics of vasodilators. Part II. Clin Pharmacokinet. 1998 Abstract
  22. Atkinson HC, Begg EJ, Darlow BA. Drugs in human milk. Clinical pharmacokinetic considerations. Clin Pharmacokinet. 1988 Abstract
  23. Riant P, Urien S, Albengres E, Duche JC, Tillement JP. High plasma protein binding as a parameter in the selection of betablockers for lactating women. Biochem Pharmacol. 1986 Abstract
  24. Livingstone I, Craswell PW, Bevan EB, Smith MT, Eadie MJ. Propranolol in pregnancy three year prospective study. Clin Exp Hypertens B. 1983 Abstract
  25. Smith MT, Livingstone I, Hooper WD, Eadie MJ, Triggs EJ. Propranolol, propranolol glucuronide, and naphthoxylactic acid in breast milk and plasma. Ther Drug Monit. 1983 Abstract
  26. Thorley KJ, McAinsh J. Levels of the beta-blockers atenolol and propranolol in the breast milk of women treated for hypertension in pregnancy. Biopharm Drug Dispos. 1983 Abstract
  27. Taylor EA, Turner P. Anti-hypertensive therapy with propranolol during pregnancy and lactation. Postgrad Med J. 1981 Abstract Full text (link to original source) Full text (in our servers)
  28. Lewis AM, Patel L, Johnston A, Turner P. Mexiletine in human blood and breast milk. Postgrad Med J. 1981 Abstract Full text (link to original source) Full text (in our servers)
  29. Bauer JH, Pape B, Zajicek J, Groshong T. Propranolol in human plasma and breast milk. Am J Cardiol. 1979 Abstract Full text (link to original source)
  30. Anderson PO, Salter FJ. Letter: Propranolol therapy during pregnancy and lactation. Am J Cardiol. 1976 Abstract Full text (link to original source)
  31. Karlberg B, Lundberg D, Aberg H. Letter: Excretion of propranolol in human breast milk. Acta Pharmacol Toxicol (Copenh). 1974 Abstract
  32. Levitan AA, Manion JC. Propranolol therapy during pregnancy and lactation. Am J Cardiol. 1973 Abstract Full text (link to original source)

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