Lisinopril and Breastfeeding

Summary of use during lactation

Because of the low levels of lisinopril in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants.

Drug levels in milk and infant serum

Maternal Levels. Five women who were taking lisinopril and had donated milk samples to a breastmilk repository had their milk analyzed for lisinopril. Milk samples were collected under steady-state conditions at time intervals of 0, 1, 2, 4, 6, 8, 10, 12, and 24 hours after a dose. One woman was taking 5 mg daily, and two each were taking 10 and 20 mg daily. Milk lisinopril measurements were adjusted (doubled or halved) to a standard 10 mg daily dosage. The peak concentration of lisinopril was 0.63 mcg/L and occurred at an average of 4 hours after the dose. The average lisinopril concentration was 0.49 mcg/L, which corresponds to an infant daily dose of 0.073 mcg/kg daily and a relative infant dose of 0.06%.[1] Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

Five women who were taking lisinopril reported any perceived adverse effects in their infants. Four taking doses of 5, 10 and 20 mg daily reported no adverse effects in their infants. One had taken 5 mg of lisinopril daily and breastfed her 1-year-old since birth, exclusive probably through 6 months and extensively thereafter. The fifth women reported that her infant’s “poop smelled unpleasant and was often green”, but she continued breastfeeding and taking lisinopril.[1] It is not clear if the infant’s condition was related to lisinopril.

Effects on lactation and breastmilk

In a pilot study of the treatment of patients with postpartum hypertension, patients were randomized to either 12.5 mg hydrochlorothiazide plus 10 mg of lisinopril (n = 31) or 30 mg of nifedipine (n = 36) daily. The dosages could be increased to 12.5 mg hydrochlorothiazide plus 20 mg of lisinopril and then to 25 mg hydrochlorothiazide with 20 mg lisinopril. Nifedipine dosage was increased in 30 mg increments to a maximum daily dose of 120 mg daily. At discharge, 21 hydrochlorothiazide-lisinopril mothers (70%) were breastfeeding while19 nifedipine mothers (53%) were breastfeeding.[2]

Alternative drugs to consider

Benazepril, Captopril, Enalapril, Quinapril

References

1. Chugh J, Dai J, Datta P, et al. Investigating the transfer of lisinopril into human milk: A quantitative analysis. J Cardiovasc Pharmacol 2025;85:84–7.39405564 PubMed
2. Fishel Bartal M, Blackwell SC, Pedroza C, et al. Oral combined hydrochlorothiazide and lisinopril vs nifedipine for postpartum hypertension: a comparative-effectiveness pilot randomized controlled trial. Am J Obstet Gynecol 2023;228:571.e1–.e10.