Table 1: Compatibility of Medicines Used in PPCM Management With Breastfeeding.
| Drug | Use in Breastfeeding | Infant Monitoring | Comments |
|---|---|---|---|
| Diuretics | |||
| Furosemide | Caution | Fluid loss, dehydration, lethargy and adequate weight gain | Preferred choice loop diuretic Used in neonates from birth |
| Bumetanide | Caution | ||
| Bendroflumethiazide | Caution | Preferred choice thiazide diuretic | |
| Metolazone | Caution | ||
| Inotropes and Vasodilators | |||
| Noradrenaline | Yes – negligible risk | Nil | |
| Dobutamine | Yes – negligible risk | Nil | No oral bioavailability for the infant |
| Glyceryl trinitrate (short term use) | Caution | Flushing after feeding | |
| Levosimendan | Extreme caution | Hypotension, cardiac arrhythmias, hypokalemia, anaemia and gastrointestinal disturbances | If given, continue to monitor infant for a week after cessation of therapy |
| Milrinone | Avoid | Monitoring not required since abstinence period eliminates risk | Concomitant breastfeeding not recommended: express and discard during infusion and for 8–10 hours after |
| Blockade of the Rennin Angiotensin System | |||
| ACE* inhibitor | Caution | Hypotension, drowsiness, lethargy, poor feeding and weight gain. If used in a neonate, monitor renal function | Enalapril considered first-line |
| ARB† (although ACE inhibitor considered firstline) | Caution | Losartan considered preferred choice | |
| Sacubitril valsartan | Caution | ||
| If sacubitril valsartan used, also monitor for hyperkalemia | |||
| Mineralocorticoid Receptor Antagonists | |||
| Spironolactone | Yes – low risk | Fluid loss, dehydration, lethargy and adequate weight gain | Spironolactone considered preferred choice |
| Eplerenone | Caution | ||
| Beta-blockers | |||
| Metoprolol | Yes – low risk | Metoprolol preferred choice (if available), followed by carvedilol | |
| Bisoprolol | Caution | Drowsiness, lethargy, beta-blockade (especially bradycardia), poor feeding and weight gain | |
| Carvedilol | Caution | ||
| Nebivolol | Extreme caution | ||
| Other Pharmacological Treatments | |||
| Digoxin | Yes – negligible risk | No special monitoring required | |
| Hydralazine | Yes – negligible risk | No special monitoring required | |
| Isosorbide dinitrate | Caution | Drowsiness, lethargy, poor feeding and weight gain | |
| Ivabradine | Extreme caution | Bradycardia and arrhythmias, poor feeding and weight gain | |
ACE = angiotensin-converting enzyme; ARB = angiotensin II receptor blockers.