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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="Drugs and Lactation Database (LactMed®) [Internet]" /><meta name="citation_title" content="Propranolol" /><meta name="citation_publisher" content="National Institute of Child Health and Human Development" /><meta name="citation_date" content="2024/11/15" /><meta name="citation_pmid" content="30000221" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK501162/" /><meta name="citation_keywords" content="propranolol" /><meta name="citation_keywords" content="Propanolol" /><meta name="citation_keywords" content="Avlocardyl" /><meta name="citation_keywords" content="Dociton" /><meta name="citation_keywords" content="Anapriline" /><meta name="citation_keywords" content="Euprovasin" /><meta name="citation_keywords" content="Betalong" /><meta name="citation_keywords" content="Proprasylyt" /><meta name="citation_keywords" content="Propanix" /><meta name="citation_keywords" content="Reducor" /><meta name="citation_keywords" content="propranololo" /><meta name="citation_keywords" content="Corpendol" /><meta name="citation_keywords" content="Betadren" /><meta name="citation_keywords" content="Sawatal" /><meta name="citation_keywords" content="Sumial" /><meta name="citation_keywords" content="Propranololum" /><meta name="citation_keywords" content="Propranololo [DCIT]" /><meta name="citation_keywords" content="UNII-9Y8NXQ24VQ" /><meta name="citation_keywords" content="CCRIS 3082" /><meta name="citation_keywords" content="9Y8NXQ24VQ" /><meta name="citation_keywords" content="EINECS 208-378-0" /><meta name="citation_keywords" content="AY-20694" /><meta name="citation_keywords" content="AY 20694" /><meta name="citation_keywords" content="1-naphthalen-1-yloxy-3-(propan-2-ylamino)propan-2-ol" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Propranolol" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Institute of Child Health and Human Development" /><meta name="DC.Date" content="2024/11/15" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK501162/" /><meta name="description" content="Because of the low levels of propranolol in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. Studies during breastfeeding have found no adverse reactions in breastfed infants clearly attributable to propranolol. No special precautions are required. Propranolol has been used successfully in cases of persistent pain of the breast during breastfeeding.[1]" /><meta name="og:title" content="Propranolol" /><meta name="og:type" content="book" /><meta name="og:description" content="Because of the low levels of propranolol in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. Studies during breastfeeding have found no adverse reactions in breastfed infants clearly attributable to propranolol. No special precautions are required. Propranolol has been used successfully in cases of persistent pain of the breast during breastfeeding.[1]" /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK501162/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-lactmed-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/lactmed/LM301/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK501162/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} </style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script>
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. </p></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK501162_"><span class="title" itemprop="name">Propranolol</span></h1><p class="small">Last Revision: <span itemprop="dateModified">November 15, 2024</span>.</p><p><em>Estimated reading time: 4 minutes</em></p></div><div class="body-content whole_rhythm" itemprop="text"><p>CASRN: 525-66-6</p><a href="https://pubchem.ncbi.nlm.nih.gov/substance/134978179" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=134978179" alt="image 134978179 in the ncbi pubchem database" /></a><div id="LM301.Drug_Levels_and_Effects"><h2 id="_LM301_Drug_Levels_and_Effects_">Drug Levels and Effects</h2><div id="LM301.Summary_of_Use_during_Lactation"><h3>Summary of Use during Lactation</h3><p>Because of the low levels of propranolol in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. Studies during breastfeeding have found no adverse reactions in breastfed infants clearly attributable to propranolol. No special precautions are required. Propranolol has been used successfully in cases of persistent pain of the breast during breastfeeding.[<a class="bk_pop" href="#LM301.REF.1">1</a>]</p></div><div id="LM301.Drug_Levels"><h3>Drug Levels</h3><p>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.[<a class="bk_pop" href="#LM301.REF.2">2</a>] Accumulation of the drugs in the infant is related to the fraction excreted in urine. With 87% protein binding, less than 1% renal excretion and a moderate half-life, propranolol presents a low risk for accumulation in infants.</p><p><i>Maternal Levels.</i> One woman receiving propranolol 20 mg orally every 8 hours had milk propranolol levels between 0 and 5 mcg/L at various times after a dose during days 2 and 5 postpartum.[<a class="bk_pop" href="#LM301.REF.3">3</a>]</p><p>A woman taking propranolol 10 mg every 8 hours was given a single 40 mg dose. The peak milk level was 30 mcg/L at 2 hours after the dose.[<a class="bk_pop" href="#LM301.REF.4">4</a>,<a class="bk_pop" href="#LM301.REF.5">5</a>]</p><p>Five postpartum women taking oral propranolol 40 mg twice daily had average milk levels of 27 mcg/L (range 14 to 36 mcg/L) at 2 hours after a dose.[<a class="bk_pop" href="#LM301.REF.6">6</a>]</p><p>Milk propranolol levels were 50 to 60 mcg/L at 3 hours after an 80 mg oral dose in 2 women and 110 to 120 mcg/L in the same women 3 hours after a 160 mg oral dose.[<a class="bk_pop" href="#LM301.REF.7">7</a>]</p><p>A woman received single oral doses of propranolol 40 mg on two days. Peak propranolol levels in milk were 4 and 9 mcg/L and occurred from 2 to 4 hours after the doses. Subsequently, she began propranolol 40 mg 4 times daily, with peak milk propranolol levels of about 42 mcg/L occurring 3 hours after a dose. Her propranolol dose was increased to 240 mg daily. Thirty days later, her pre-dose and 3-hour post-dose milk propranolol levels were 26 and 64 mcg/L, respectively.[<a class="bk_pop" href="#LM301.REF.8">8</a>]</p><p>A woman was taking propranolol 20 mg twice daily throughout pregnancy and postpartum. She donated 4 hindmilk samples at various times after her dose. Milk levels ranged from not detectable (<2 mcg/L) at 12 hours after a dose to 20 mcg/L at 1 to 2 hours after a dose.[<a class="bk_pop" href="#LM301.REF.9">9</a>]</p><p>Three women were studied during the first week postpartum. Two women receiving 1.1 to 1.2 mg/kg daily of oral propranolol had milk concentrations ranging from 14 to 75 mcg/L over the 8-hour period after a dose. In one woman, propranolol glucuronide added slightly to the total propranolol concentration in milk, primarily after 4 hours. A third woman was taking 2.6 mg/kg daily by mouth and had propranolol plus propranolol glucuronide concentrations of 46 to 75 mcg/L in her milk over the time period of 4.5 to 8 hours after her dose.[<a class="bk_pop" href="#LM301.REF.10">10</a>]</p><p>A fully breastfed infant would receive between <0.1 and 0.9% of the weight-adjusted maternal dosage of propranolol.[<a class="bk_pop" href="#LM301.REF.10">10</a>,<a class="bk_pop" href="#LM301.REF.11">11</a>]</p><p><i>Infant Levels.</i> Relevant published information was not found as of the revision date.</p></div><div id="LM301.Effects_in_Breastfed_Infants"><h3>Effects in Breastfed Infants</h3><p>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. Of 8 mothers taking propranolol, one reported sleepiness in her breastfed infant, but she was also taking other unspecified drugs for hypertension.[<a class="bk_pop" href="#LM301.REF.12">12</a>]</p><p>A case of bradycardia in a 2-day-old breastfed infant was reported to the French pharmacovigilance system. However it is not clear from the report whether the mother had been taking propranolol near term and might have transmitted the drug to the infant transplacentally.[<a class="bk_pop" href="#LM301.REF.13">13</a>]</p><p>A prospective study of pregnant patients taking a beta-blocker asked mothers to complete a questionnaire about postpartum breastfeeding and any side effects in their breastfed infants. Sixteen mothers reported taking propranolol in unreported dosages while breastfeeding. Three women reported hypoglycemia in their infant with “a favorable outcome” and one reported bradycardia in her child with discontinuation of propranolol after 3 weeks of breastfeeding.[<a class="bk_pop" href="#LM301.REF.14">14</a>]</p></div><div id="LM301.Effects_on_Lactation_and_Breastmil"><h3>Effects on Lactation and Breastmilk</h3><p>Relevant published information on the effects of beta-blockade or propranolol 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.[<a class="bk_pop" href="#LM301.REF.15">15</a>]</p></div><div id="LM301.Alternate_Drugs_to_Consider"><h3>Alternate Drugs to Consider</h3><p>(Cardiovascular) <a href="/books/n/lactmed/LM291/">Labetalol</a>, <a href="/books/n/lactmed/LM296/">Metoprolol</a>; (Migraine Prophylaxis) <a href="/books/n/lactmed/LM437/">Divalproex</a>, <a href="/books/n/lactmed/LM1386/">Erenumab</a>, <a href="/books/n/lactmed/LM296/">Metoprolol</a>, <a href="/books/n/lactmed/LM314/">Nortriptyline</a>, <a href="/books/n/lactmed/rimegepant/">Rimegepant</a>, <a href="/books/n/lactmed/LM390/">Topiramate</a>, <a href="/books/n/lactmed/LM403/">Valproic Acid</a></p></div><div id="LM301.References"><h3>References</h3><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="LM301.REF.1">Muddana
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A, Asbill
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DT, Jerath
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Quantitative sensory testing, antihistamines, and beta-blockers for management of persistent breast pain: A case series.
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Breastfeed Med
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[<a href="https://pubmed.ncbi.nlm.nih.gov/29630399" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29630399</span></a>]</div></dd><dt>2.</dt><dd><div class="bk_ref" id="LM301.REF.2">Riant
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P, Urien
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High plasma protein binding as a parameter in the selection of betablockers for lactating women.
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Biochem Pharmacol
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[<a href="https://pubmed.ncbi.nlm.nih.gov/2878668" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2878668</span></a>]</div></dd><dt>3.</dt><dd><div class="bk_ref" id="LM301.REF.3">Lewis
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AM, Patel
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Mexiletine in human blood and breast milk.
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AA, Manion
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JC. Propranolol therapy during pregnancy and lactation.
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Am J Cardiol
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[<a href="https://pubmed.ncbi.nlm.nih.gov/4721124" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4721124</span></a>]</div></dd><dt>5.</dt><dd><div class="bk_ref" id="LM301.REF.5">Anderson
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PO, Salter
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FJ. Propranolol therapy during pregnancy and lactation.
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Am J Cardiol
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1976;37:325.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/1246962" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1246962</span></a>]</div></dd><dt>6.</dt><dd><div class="bk_ref" id="LM301.REF.6">Thorley
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KJ, McAinsh
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J. Levels of the beta-blockers atenolol and propranolol in the breast milk of women treated for hypertension in pregnancy.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/6626704" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6626704</span></a>]</div></dd><dt>7.</dt><dd><div class="bk_ref" id="LM301.REF.7">Karlberg
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H. Excretion of propranolol in human breast milk.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/4406326" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4406326</span></a>]</div></dd><dt>8.</dt><dd><div class="bk_ref" id="LM301.REF.8">Bauer
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JH, Pape
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Propranolol in human plasma and breast milk.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/425926" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 425926</span></a>]</div></dd><dt>9.</dt><dd><div class="bk_ref" id="LM301.REF.9">Taylor
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EA, Turner
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P. Anti-hypertensive therapy with propranolol during pregnancy and lactation.
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[<a href="/pmc/articles/PMC2424946/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2424946</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/7312737" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7312737</span></a>]</div></dd><dt>10.</dt><dd><div class="bk_ref" id="LM301.REF.10">Smith
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MT, Livingstone
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I, Hooper
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Propranolol, propranolol glucuronide, and naphthoxylactic acid in breast milk and plasma.
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Ther Drug Monit
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[<a href="https://pubmed.ncbi.nlm.nih.gov/6845404" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6845404</span></a>]</div></dd><dt>11.</dt><dd><div class="bk_ref" id="LM301.REF.11">Atkinson
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HC, Begg
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[<a href="https://pubmed.ncbi.nlm.nih.gov/3292101" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3292101</span></a>]</div></dd><dt>12.</dt><dd><div class="bk_ref" id="LM301.REF.12">Ho
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[<a href="https://pubmed.ncbi.nlm.nih.gov/25183382" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25183382</span></a>]</div></dd><dt>14.</dt><dd><div class="bk_ref" id="LM301.REF.14">Freppel
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[<a href="https://pubmed.ncbi.nlm.nih.gov/556882" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 556882</span></a>]</div></dd></dl></div></div><div id="LM301.Substance_Identification"><h2 id="_LM301_Substance_Identification_">Substance Identification</h2><div id="LM301.Substance_Name"><h3>Substance Name</h3><p>Propranolol</p></div><div id="LM301.CAS_Registry_Number"><h3>CAS Registry Number</h3><p>525-66-6</p></div><div id="LM301.Drug_Class"><h3>Drug Class</h3><p>Breast Feeding</p><p>Lactation</p><p>Milk, Human</p><p>Antihypertensive Agents</p><p>Adrenergic Beta-Antagonists</p><p>Antiarrhythmics</p></div></div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_top_margin"><p><b>Disclaimer: </b>Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.</p></p></div></dd></dl></div><div id="bk_toc_contnr"></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a><p class="small"><b>Attribution Statement:</b> LactMed is a registered trademark of the U.S. Department of Health and Human Services.</p></div><div class="small"><span class="label">Bookshelf ID: NBK501162</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/30000221" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">30000221</a></span></div><div style="margin-top:2em" class="bk_noprnt"><a class="bk_cntns" href="/books/n/lactmed/">Contents</a><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/lactmed/LM382/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/lactmed/LM230/" title="Next page in this title">Next ></a></div></div></div></div>
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