Lactation safety of cardiovascular medications

Breastfeeding is the gold standard for infant feeding with well-established maternal, neonatal, and pediatric benefits. Patients with preexisting cardiovascular disease have lower breastfeeding rates than the general population. While little evidence exists regarding specific barriers to lactation in patients with preexisting cardiovascular disease, concerns regarding lactation safety and medication exposure in mothers with cardiovascular disease may be a cause for early breastfeeding cessation despite known health benefits. This literature review highlights the lactation safety of common cardiac medications. While some common cardiac medications may have limited safety data available, general pharmacokinetic principles of drug secretion in lactation can help to guide shared decision making in discussion with the patient. Enhancing provider knowledge regarding cardiac medication safety during breastfeeding may improve lactation outcomes in this population.