Because of its relatively extensive excretion into breastmilk and its renal excretion, otherbeta-adrenergic blocking drugs are preferred to nadolol, especially while nursing a newborn or preterm infant.
The excretion ofbeta-adrenergic blocking drugs into breastmilk is largely determined by their protein binding. Those with low binding are more extensively excreted into breastmilk. Accumulation of the drugs in the infant is related to the fraction excreted in urine. With 25% protein binding, 70% renal excretion and long half-life, nadolol presents a high risk for accumulation in infants, especially neonates. It is estimated that a fully breastfed infant would receive about 5.1% of the maternal weight-adjusted dosage of nadolol.
One mother received nadolol 20 mg daily during gestation for hypertension, with the last dose taken 20 hours before delivery. A single sample of breastmilk obtained 38 hours postpartum (58 hours after the last dose) was 146 mcg/L.
After oral doses of 80 mg daily in 12 women, peak nadolol levels occurred in milk at an average of 6 hours after the dose, compared to peak serum levels at 2.7 hours. Serum and milk half-lives were both about 22 hours. Steady-state milk levels occurred after 3 days of therapy; peak milk levels averaged 443 mcg/L and the mean milk levels averaged 357 mcg/L. None of the infants were breastfed.
Relevant published information was not found as of the revision date.
Effects in Breastfed Infants:
A study of mothers takingbeta-blockers during nursing found a numerically, but not statistically significant increased number of adverse reactions in those taking anybeta-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 nadolol.
Possible Effects on Lactation:
Relevant published information on the effects ofbeta-blockade or nadolol 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 followingbeta-adrenergic blockade with propranolol.
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. Atkinson HC, Begg EJ, Darlow BA. Drugs in human milk. Clinical pharmacokinetic considerations. Clin Pharmacokinet. 1988;14:217-40. PMID:3292101 3. Fox RE, Marx C, Stark AR. Neonatal effects of maternal nadolol therapy. Am J Obstet Gynecol. 1985;152:1045-6. PMID:4025452 4. Devlin RG, Fleiss PM. Nadolol excretion in human milk. Clin Pharmacol Ther. 1981;29:240. Abstract. 5. Devlin RG, Duchin KL, Fleiss PM. Nadolol in human serum and breast milk. Br J Clin Pharmacol. 1981;12:393-6. PMID:6117304 6. Ho TK, Moretti ME, Schaeffer JK et al. Maternalbeta-blocker usage and breast feeding in the neonate. Pediatr Res. 1999;45:67A. Abstract 385. 7. Board JA, Fierro RJ, Wasserman AJ et al. Effects of alpha- andbeta-adrenergic blocking agents on serum prolactin levels in women with hyperprolactinemia and galactorrhea. Am J Obstet Gynecol. 1977;127:285-7. PMID:556882
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