Labetalol, metoprolol or propranolol are the beta-blockers of choice during breastfeeding. Recommendations apply to full term and healthy infants only.

General considerations

It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing in breastfeeding when looking at the available information and making treatment decisions.


Labetalol, metoprolol, and propranolol are the beta-blockers of choice during breastfeeding.

Very small amounts get into breast milk, and they have shorter half-lives leading to a lower risk of accumulation in a breastfed infant. Labetalol and metoprolol also do not rely on excretion in the urine, again leading to less risk of accumulation.

Labetalol and propranolol are used therapeutically in neonates, and metoprolol in infants from one month of age.

However, any beta-blocker may be used during breastfeeding if clinically appropriate, although more careful monitoring may be required.

Clinical considerations

Different beta-blockers have slightly different properties and they are used for a variety of indications, both licensed and off-label.

Treatment choice should primarily be directed at controlling symptoms, with suitability in breastfeeding a secondary consideration.

For some indications a combination of medicines may be required and therefore their additive suitability in breastfeeding will need to be considered.

There is no need to change a beta-blocker used successfully during pregnancy to a preferred choice in breastfeeding as long as the infant has been born full term and healthy.

See also our advice on ACE inhibitors, calcium-channel blockers and angiotensin-II receptor antagonists.

Breastfeeding itself can also help to reduce the risk of cardiovascular disease, including a protective effect against hypertension.

Some beta blockers are only available as eye drops.

Effect on breastfeeding

Beta-blockers are not known to have an effect on breastfeeding. However, non-selective beta-blockers (especially labetalol) have been reported to cause nipple pain or Raynaud’s phenomenon of the nipple.

Specific recommendations

Patient Information

The NHS website provides advice for patients on the use of specific beta-blockers in breastfeeding.

Further Advice

Get in touch with the UK Drugs In Lactation Advisory Service (UKDILAS), our specialist breastfeeding medicines advice service, if:

  • the infant is unwell or premature
  • multiple medicines are being taken
  • the medicine in question is not included in our advice
  • you need further advice

About our recommendations

Recommendations are based on published evidence where available. However, evidence is generally very poor and limited, and can require professional interpretation. Assessments are often based on reviewing case reports which can be conflicting and lack detail.

If there is no published clinical evidence, assessments are based on: pharmacodynamic and pharmacokinetic principles, extrapolation from similar drugs, risk assessment of normal clinical use, expert advice, and unpublished data. Simulated data are now increasingly being used due to the ethical difficulties around gathering good quality evidence in this area.


Full referencing is available on request.

Update history

  1. Minor editorial amendment
  1. Published

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