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Breast Feeding

Hypertension medication troubles and nursing.

08/08/2000

Question:

I am currently breastfeeding my 16 month old daughter. I have been taking Aldomet (methyldopa) since I was 3 months pregnant with her. My doctor recently increased my dosage to 500 mgs, twice per day as my usual dosage of 250 mgs, 3 times per day was no longer working. Since I have had the dosage increase (a month), my legs and ankles have been swelling daily. They also have a "tired, heavy" feeling. My doctor has a hard time with medicating me while nursing, plus, my husband I and do not believe in using birth control (religious reasons) so whatever medication I take, it needs to be safe for breastfeeding as well as a possible pregnancy. While we are not actively seeking another pregnancy, there is no guarantee that I would not become pregnant.

I am concerned about the leg/ankle swelling. Do you have any suggestions for me? Thank you!

Answer:

Congratulations on your long-term breastfeeding relationship with your daughter. As a lactation consultant I will comment mainly about the possible effect the medication may have on breastfeeding and lactation. You may want to send your question to other NetWellness experts for information about the other aspects of hypertension (high blood pressure) or circulatory condition that has required the continued use of Aldomet.

I would need more information to address the issue of your doctor having a difficult time medicating you while you breastfeed, as I don`t understand his/her exact concern. Also, I`m not certain what information you need regarding your physical response to the dosage change in the Aldomet, as breastfeeding/lactation usually wouldn`t influence or be influenced by that response. If the concern is that substituting another medication may interfere with continuing to breastfeed your toddler, you and your doctor may be relieved to learn that there are several antihypertensive medications considered compatible with breastfeeding and lactation. (See references below.)

Medications that are not considered "safe" for a fetus during pregnancy may be compatible with breastfeeding. The reverse can also be true-a few medications that are considered to be relatively safe during pregnancy are not appropriate when breastfeeding. The placenta and the breast "screen," or allow, a medication or its byproducts to pass to the fetus/baby differently. Also, the effect of a medication (or its byproducts) in breast milk varies depending on a baby`s age and overall diet. For instance, a concern about the effect of a medication in the breast milk received by the more mature toddler, whose diet also consists of several solid food meals, usually is very different from any concern for a newborn who is taking only breast milk. (Fortunately, for most maternal health conditions, there usually are breastfeeding-compatible medications for the newborn period.)

I hope you get your condition under control soon, as a mother`s health has a tremendous impact on the entire family. Hypertension and other circulatory conditions can contribute to complications for both a mother and the fetus/baby she carries during pregnancy. Because of this, you and your husband may want to discuss your current health condition, and any implications for complications during a subsequent pregnancy, with both your obstetrician-gynecologist, or a perinatologist-a specialist in pregnancy complications, and your spiritual advisor or pastor.

All the best to you and your baby. Please feel free to send more information if you need a more specific answer.

References:

Hale, TW (1999). Clinical therapy in breastfeeding patients. Amarillo, TX: Pharmasoft Medical Publishing.

Hale, TW (1999). Medications and mothers` milk (8th ed.). Amarillo, TX: Pharmasoft Medical Publishing.

For more information:

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Response by:

Karen Kerkhoff Gromada, MSN, RN, IBCLC
Adjunct Clinical Instructor
College of Nursing
University of Cincinnati