Nifedipine and verapamil are the calcium-channel 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.


There are two sub-classes of calcium-channel blockers—dihydropyridines and rate-limiting—which are not usually interchangeable therapeutically.  We have therefore only given recommended alternatives within the same sub-class.

Nifedipine (a dihydropyridine) and verapamil (rate-limiting) are the preferred calcium-channel blockers during breastfeeding, as published evidence is available about their excretion into breast milk and they have the most favourable pharmacokinetics.  Additionally, nifedipine has been used therapeutically in infants.

Recommendations apply to any indication the medicine is being used for and to any formulation, including modified-release preparations.

Choice considerations

Clinical actions of calcium-channel blockers vary widely and they are used for a variety of indications, both licensed and off-label.  These include hypertension, angina, arrhythmias, Raynaud’s phenomenon and cluster headache.  Nifedipine is also used for painful nipple spasm which can occur during breastfeeding.

Treatment choice should be primarily directed at controlling symptoms, with suitability in breastfeeding as 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.

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

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

Specific recommendations

Patient Information

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

Contact us

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

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

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.

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