Safety in Lactation: Drugs used for angina

Sarah Fenner, Specialist MI Pharmacist, Midlands and East Medicines Advice Service (Midlands site) & UK Drugs in Lactation Advisory ServicePublished

Additional information relating to breastfeeding

To be used in conjunction with individual drug entries for specific information and guidance.

Anti-anginal nitrates

Nitrates are indicated for prevention/treatment of angina and for heart failure. Their use in breastfeeding mothers is therefore likely to be rare.

As a precaution, monitor infants for flushing after feeding if shorter-acting formulations or injections are used.

Infants under 6 months are most at risk of nitrate intoxication due to their susceptibility to methaemaglobinaemia, although the risk is small and only with higher doses or long-term use.

Other anti-anginals

Due to a complete lack of evidence, ivabradine, nicorandil and ranolazine should be used with extreme caution in breastfed infants. The effects of exposure of infants to low levels in breast milk is unknown.