Can you take nitroprusside while breastfeeding?
What LactMed says
The National Library of Medicine’s own summary, quoted in full. We do not write a verdict of our own on this question, and we do not compress theirs into a label.
Breastmilk levels of nitroprusside sodium have not been measured after exogenous administration. Because of its short half-life of 2 minutes, it is unlikely to appear in breastmilk. However, its toxic metabolite, thiocyanate, is excreted into milk and can be directly toxic to the infant as well as inhibiting iodide transport into breastmilk. Cyanide is another toxic metabolite of nitroprusside that may enter breastmilk. An alternate drug is therefore preferred during breastfeeding. If use of nitroprusside sodium is unavoidable, the mother should refrain from breastfeeding.
Quoted from Nitroprusside — Drugs and Lactation Database (LactMed®), National Institute of Child Health and Human Development, revised November 15, 2024.
What LactMed would consider instead
LactMed ends this record by naming the drugs it would consider in place of nitroprusside. Whether any of them fits depends on what you are treating — this is the database’s list, not a recommendation from us.
How much nitroprusside gets into breastmilk
Nitroprusside is converted with a half-life of about 2 minutes to cyanide and then to thiocyanate in the body. Both of these metabolites have longer half-lives: 7.3 hours for cyanide and an estimated 3 days to 2 weeks for thiocyanate.
Maternal Levels. An older study found that thiocyanate passed into human breastmilk in concentrations from 27% to 50% of maternal serum levels. A later study found milk levels to range from 16% to 42% of maternal plasma levels. A 2004 study found values ranging from 42% to 82%, while a more recent study reported fractional excretion of thiocyanate that ranged between 1.4-14.4%.
Infant Levels. Relevant published information was not found as of the revision date.
What has been seen in breastfed infants
Several studies have found that breastmilk iodine levels are inversely related to the mothers' blood thiocyanate levels, probably through inhibition of the Na/I symporter by thiocyanate. However, a recent study failed to demonstrate such a correlation. The authors felt that the effect of thiocyanate on iodine transport may be less pronounced than previously reported. These low breastmilk iodine levels might pose a risk of hypothyroidism to breastfed infants whose mothers have low iodine intake.
Effects on milk supply
Relevant published information was not found as of the revision date.
Frequently asked questions
Can you take nitroprusside while breastfeeding?
Breastmilk levels of nitroprusside sodium have not been measured after exogenous administration. The full record is quoted on this page, and the decision is one to make with the person who prescribed it — LactMed itself states it is not a substitute for professional judgement.
What can I take instead of nitroprusside while breastfeeding?
LactMed lists Candesartan, Benazepril, Captopril, Enalapril, Lisinopril, Quinapril, Hydralazine, Hydrochlorothiazide, Methyldopa, Propranolol as alternate drugs to consider. That is the database's own list for this drug — whether any of them suits you depends on what you are treating.
Does nitroprusside pass into breastmilk?
LactMed's measured drug levels for nitroprusside are quoted in full on this page, under "How much gets into breastmilk".
Do I need to pump and dump after taking nitroprusside?
LactMed does not frame its records that way — it reports measured drug levels in milk and what has been observed in breastfed infants, which is what this page quotes. "Pump and dump" advice for a specific drug and dose should come from your clinician or a pharmacist, not from a general rule.
More on nitroprusside
LactMed states that the information it presents is not a substitute for professional judgement, and that you should consult your healthcare provider for breastfeeding advice related to your particular situation. Nothing on this page is medical advice.