Is it safe to breastfeed while taking lisinopril?

In this article:

• Lisinopril nursing considerations
• How long to wait
• Side effects
• Lisinopril safety while breastfeeding
• The bottom line

In this article

• Lisinopril nursing considerations
• How long to wait
• Side effects
• Lisinopril safety while breastfeeding
• The bottom line

Lisinopril is an oral antihypertensive medication commonly used to treat high blood pressure and heart failure—and to improve survival after a heart attack. Lisinopril can also be used to treat chronic kidney disease or prevent migraines.

Lisinopril belongs to a class of medications known as angiotensin-converting enzyme inhibitors (ACE inhibitors). ACE inhibitors help to relax blood vessels (vasodilation), improve blood flow, and lower blood pressure. Specifically, lisinopril works by blocking the action of the ACE enzyme, which converts angiotensin I into angiotensin II, a potent vasoconstrictor. This is referred to as its mechanism of action.

If you’re a new parent, you may be wondering if lisinopril is safe to take while breastfeeding. The answer is, unfortunately, not straightforward. The safety of taking lisinopril while breastfeeding is currently unknown, although it is generally thought to be safe. Your healthcare provider can help you weigh the risks and benefits of the medication for your situation.

Can you take lisinopril while nursing?

There are currently no studies on the safety of lisinopril while nursing. That does not necessarily mean that it is unsafe to take, but it does mean that there is no data proving it is risk-free.

Lisinopril is sold under the brand names Zestril, Qbrelis, and Prinivil. It is also available as a combination medication with hydrochlorothiazide (a diuretic) called Zestoretic. “Because no information is available on the use of lisinopril during breastfeeding, an alternate drug may be preferred, especially while making milk for a newborn, a preterm infant, or a medically fragile infant,“ Sunayana Weber, IBCLC, a lactation consultant at It’s More than Milk in Austin, Texas, says.

Some healthcare providers may prescribe lisinopril to breastfeeding women. Others may prefer to prescribe an alternative ACE inhibitor, such as enalapril, captopril, or quinapril. Enalapril is usually the preferred drug because there are studies on how it affects breastfeeding infants. One study found that the amount of enalapril that an exclusively breastfed infant would ingest would be about 0.16% of the maternal weight-adjusted dosage. Enalapril does not have adverse effects on milk supply.

It’s likely best to try this ACE inhibitor over lisinopril: “If a parent needs to be on an ACE inhibitor while breastfeeding, I would stick with one that has been studied and is deemed safe during lactation, such as enalapril or captopril,” says Jessica Madden, MD, IBCLC, a board-certified pediatrician and neonatologist, and medical director of Aeroflow Breastpumps. “Research has shown that only small amounts of these medications pass into mothers’ milk, and in the limited studies available, there have been no documented adverse effects of captopril or enalapril on breastfed infants.”

Your healthcare provider can help you assess the risks and benefits of taking lisinopril for your situation. One of the main factors to consider is your baby’s age. Lisinopril could cause kidney dysfunction in newborns or contribute to impaired renal function in premature infants. “By the time an infant is 2 months or older, the risk of side effects from ACE inhibitors is much lower, so in most cases, it is probably safe for a mother to take one during lactation,” says Dr. Madden.

When you’re breastfeeding, make sure to tell all of your healthcare providers—whether it’s your primary care provider or dentist. That way, your provider can check that any medication used is safe for breastfeeding infants—and let you know if it will affect your milk supply.

How long should I wait to breastfeed after taking lisinopril?

The peak concentration of lisinopril in the body is 6-8 hours after taking it orally. Lisinopril will clear the body within about 72 hours of taking it. However, there are many unknowns:

• The amount of lisinopril secreted into breastmilk
• The effects of lisinopril on a breastfeeding infant
• The amount of time that lisinopril is detectable in breast milk
• If any amount of lisinopril in breast milk will affect a baby

Because of the lack of data, there is currently no recommended time to wait to breastfeed after taking lisinopril. Rather, your healthcare provider may prescribe an alternative medication.

Side effects of lisinopril while nursing

The possible side effects of ACE inhibitors on infants include:

• Sleepiness
• Poor feeding
• Lethargy
• Weight gain

“If you are on medication for hypertension while breastfeeding and notice any of these side effects in your baby, I recommend discussing alternative treatment options with your healthcare provider as soon as possible,” says Dr. Madden.

For adults, common side effects of lisinopril include:

• Dry cough
• Blurred vision
• Cloudy urine
• Dizziness
• Low blood pressure (also called hypotension)

Less common side effects include:

• Chest pain
• Stomach pain
• Diarrhea
• Congestion
• Vomiting
• Orthostatic hypotension—a sudden decrease in blood pressure when moving from a sitting to a standing position 

One important side effect to watch out for is hyperkalemia, or high potassium levels in the blood. This is more likely to happen to people who already have kidney problems or who are taking other medications that can affect potassium levels, such as potassium-sparing diuretics, beta blockers, and angiotensin receptor blockers. Symptoms include muscle weakness, heart palpitations, and an irregular heartbeat. If you have any of these symptoms, seek medical care immediately. Avoid taking potassium supplements if you’re also taking lisinopril.

A rare but life-threatening side effect of taking lisinopril is angioedema. This happens when the face, airway, throat, and/or tongue swell. Symptoms may also include rapid skin swelling, swelling in the gut leading to nausea and pain, and swelling in the throat that causes hoarseness. If you have any of these symptoms, seek medical care immediately.

If you’ve been prescribed lisinopril, it’s important to let your provider know if you have other conditions, such as a history of angioedema, diabetes, kidney problems such as renal artery stenosis, fluid retention, electrolyte imbalance, liver disease, or collagen vascular disease. Lisinopril is generally contraindicated if these conditions are present.

Lisinopril interactions

Several kinds of drugs interact with lisinopril, including:

• Angiotensin II receptor blockers (ARBs): ARBs are another class of drugs used to lower blood pressure.
• Diuretics: Diuretics are “water pills” prescribed to treat fluid retention, often the kind associated with edema (swelling) caused by heart failure and liver and kidney problems.
• Non-steroidal anti-inflammatory drugs (NSAIDs): It’s key to avoid NSAIDs like ibuprofen or naproxen while you are on lisinopril, as mixing them can raise your risk of renal impairment (kidney damage).

You should also avoid potassium supplements if you’re also taking lisinopril because they can increase your risk of high potassium levels in the blood.

How to take lisinopril while breastfeeding

Lisinopril use during breastfeeding should be prescribed on a case-by-case basis when a healthcare provider weighs the benefits and risks for a particular mother and baby.

If you and your healthcare provider decide that taking lisinopril is the right option for you, it is key to take the medication as prescribed. That includes taking it at the appropriate dosage and time of day.

Monitor yourself and your baby for any adverse reactions. Stay in contact with your healthcare provider and keep them updated on how you feel while taking lisinopril.

The bottom line

While lisinopril might be safe to take if you’re breastfeeding, its use should be carefully considered due to the lack of research on any effects the medication may have on infants. In general, it’s probably a good idea to try another ACE inhibitor, like enalapril. To protect both your health and your baby’s, always share complete health information with your healthcare provider. This ensures they can recommend the safest approach for you and your baby while you are breastfeeding.