Bisoprolol

Drug Levels and Effects:




Summary of Use during Lactation:


Because there is little published experience with bisoprolol during breastfeeding and potentially extensive excretion into breastmilk, other agents may be preferred, especially while nursing a newborn or preterm infant.


Drug Levels:


The excretion of beta-adrenergic blocking drugs into breastmilk is largely determined by their protein binding. Those with low binding are more extensively excreted into breastmilk.[1] Accumulation of the drugs in the infant is related to the fraction excreted in urine. With 30% protein binding, 50% renal excretion and a moderately long half-life, bisoprolol presents a moderately high risk for accumulation in infants, especially neonates.

Maternal Levels.

Relevant published information was not found as of the revision date.

Infant Levels.

Relevant published information was not found as of the revision date.


Effects in Breastfed Infants:


A study of mothers taking beta-blockers during nursing found a numerically, but not statistically significant increased number of adverse reactions in those taking any beta-blocker. Although the ages of infants were matched to control infants, the ages of the affected infants were not stated. None of the mothers were taking bisoprolol.[2] Beta-adrenergic blocking drugs with breastmilk excretion characteristics similar to bisoprolol's have caused adverse effects in breastfed newborns.[3][4]


Possible Effects on Lactation:


Relevant published information on the effects of beta-blockade or bisoprolol during normal lactation was not found as of the revision date. A study in 6 patients with hyperprolactinemia and galactorrhea found no changes in serum prolactin levels following beta-adrenergic blockade with propranolol.[5]


Alternate Drugs to Consider:


Propranolol,Labetalol,Metoprolol


References:


1. Riant P, Urien S, Albengres E et al. High plasma protein binding as a parameter in the selection of betablockers for lactating women. Biochem Pharmacol. 1986;35:4579-81. PMID:2878668
2. Ho TK, Moretti ME, Schaeffer JK et al. Maternal beta-blocker usage and breast feeding in the neonate. Pediatr Res. 1999;45:67A. Abstract 385.
3. Boutroy MJ, Bianchetti G, Dubruc C, et al. To nurse when receiving acebutolol: is it dangerous for the neonate? Eur J Clin Pharmacol. 1986;30:737-9. PMID:3770068
4. Schimmel MS, Eidelman AI, Wilschanski MA et al. Toxic effects of atenolol consumed during breast feeding. J Pediatr. 1989;114:476-8. PMID:2921694
5. Board JA, Fierro RJ, Wasserman AJ et al. Effects of alpha- and beta-adrenergic blocking agents on serum prolactin levels in women with hyperprolactinemia and galactorrhea. Am J Obstet Gynecol. 1977;127:285-7. PMID:556882



Substance Identification:




Substance Name:

Bisoprolol

CAS Registry Number:

66722-44-9

Drug Class:


  • Antihypertensive Agents

  • Adrenergic Beta-Antagonists

  • Antiarrhythmics


  • Administrative Information:




    LactMed Record Number:


    285


    Last Revision Date:


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