If you're breastfeeding and need to take verapamil for high blood pressure, angina, or a heart rhythm issue, you're not alone. Thousands of nursing mothers manage heart conditions with this medication every year. But the big question remains: is it safe for your baby?
How much verapamil gets into breast milk?
Verapamil does pass into breast milk, but not in large amounts. Studies show that the average daily dose a nursing infant receives through milk is less than 1% of the mother’s weight-adjusted dose. That’s tiny-far below the level that would typically cause effects in a healthy newborn.
One 2020 study published in the Journal of Human Lactation tracked 12 breastfeeding women taking verapamil (ranging from 120 mg to 480 mg daily). The highest concentration found in breast milk was 0.26 mcg/mL. For context, a typical infant dose of verapamil for arrhythmia is around 2-5 mcg/kg per dose. Your baby would need to drink nearly 10 liters of breast milk in a day to reach even the lowest therapeutic dose.
What do real-world reports say?
There’s no strong evidence of harm in babies exposed to verapamil through breast milk. The LactMed database, maintained by the U.S. National Library of Medicine, lists verapamil as “usually compatible with breastfeeding.” That’s the highest level of safety rating for medications during lactation.
In clinical case reports from hospitals in the UK and Canada, babies whose mothers took verapamil while nursing showed no signs of low heart rate, low blood pressure, or excessive sleepiness. One mother in Bristol reported her 4-month-old daughter had slightly softer stools for the first two weeks, but nothing that required medical attention or caused discomfort. That’s the kind of minor, temporary change you might see with many medications-and it resolved on its own.
When should you be cautious?
While verapamil is generally safe, there are a few situations where extra care is needed:
- Your baby was born prematurely. Newborns under 37 weeks have underdeveloped livers and kidneys, which means they process drugs slower. If your baby is preterm, your doctor may want to monitor heart rate and feeding more closely in the first few weeks.
- Your baby has a heart condition. If your infant already has bradycardia (slow heart rate) or heart block, adding even a small amount of verapamil could worsen it. Talk to your pediatric cardiologist before starting or continuing the drug.
- You’re taking other heart medications. Combining verapamil with beta-blockers like metoprolol or other calcium channel blockers can increase the risk of low blood pressure or slow heart rate in the baby. Your doctor will check for drug interactions.
What symptoms should you watch for in your baby?
You don’t need to check your baby’s pulse daily-but do pay attention to how they’re acting. If you notice any of these signs, contact your pediatrician:
- Unusually slow or irregular heartbeat (you might notice this if your baby seems unusually tired or pale)
- Excessive sleepiness or difficulty waking for feeds
- Poor feeding or refusing to nurse
- Unexplained fussiness that doesn’t improve with cuddling or feeding
These are rare. But if they happen, it’s better to check early. Most babies show no reaction at all.
When is the best time to take verapamil?
Timing your doses can help reduce your baby’s exposure even further. Verapamil reaches its peak level in your blood about 2-3 hours after you take it. That’s also when the highest amount enters your breast milk.
Here’s a simple trick: take your dose right after you finish a feeding session. That gives your body time to clear most of the drug before the next feed. For example, if you nurse at 7 a.m., 12 p.m., and 6 p.m., take your verapamil at 8 p.m. or after your last feed. This way, your baby gets the lowest possible dose during the next feeding.
Are there better alternatives?
Some mothers ask if there’s a safer heart medication for breastfeeding. The answer depends on your condition.
For high blood pressure, labetalol is often preferred-it’s one of the most studied drugs for nursing mothers and has an even lower transfer rate into milk. Metoprolol is another option, though it can sometimes cause drowsiness in babies.
For arrhythmias, propranolol is often used and is considered safe. But if verapamil is the only drug that controls your specific rhythm problem, switching isn’t always the best move. Stability matters more than a tiny theoretical risk.
Don’t switch medications on your own. If your current treatment works, and your baby is doing well, staying on verapamil is often the safest choice.
What do experts recommend?
The American Academy of Pediatrics doesn’t list verapamil as a reason to avoid breastfeeding. The UK’s National Health Service (NHS) also considers it compatible with lactation. The World Health Organization includes verapamil on its Model List of Essential Medicines for pregnant and breastfeeding women.
Dr. Sarah Chen, a maternal-fetal medicine specialist at Bristol Royal Infirmary, says: “I’ve had over 40 patients breastfeed while taking verapamil. Only two had minor concerns-both resolved without stopping breastfeeding. The benefits of breastfeeding almost always outweigh the minimal risk.”
Can you pump and dump?
No. Pumping and dumping won’t help. Verapamil doesn’t build up in your milk-it’s cleared from your bloodstream and milk at the same rate. If you’re taking it regularly, your milk will always contain a small amount. Pumping before feeding doesn’t reduce exposure significantly, and it can hurt your milk supply.
Plus, the risk is so low that there’s no medical reason to do it. You’re not protecting your baby by discarding milk-you’re just making breastfeeding harder for yourself.
What about long-term effects?
No studies have found any long-term developmental, cognitive, or growth issues in children exposed to verapamil through breast milk. One follow-up study in Sweden tracked 87 children whose mothers took verapamil while nursing. At age 3, their motor skills, language development, and weight were all within normal ranges-no different from children whose mothers didn’t take the drug.
That’s reassuring. Breastfeeding provides lasting benefits: stronger immunity, better gut health, lower risk of obesity and diabetes. These advantages matter far more than the tiny, unproven risk from verapamil.
Final advice: Talk to your care team
You don’t have to choose between your heart health and your baby’s well-being. Verapamil is one of the more well-studied and safest options for nursing mothers with cardiovascular conditions.
Work with your cardiologist and your GP or midwife. Bring your baby’s pediatrician into the conversation. Share your concerns. Ask for a copy of your drug levels if you’re unsure. Most doctors will support you continuing to breastfeed while on verapamil-especially if your baby is full-term, feeding well, and gaining weight.
Many mothers feel guilty about taking any medication while nursing. But your health matters too. A calm, healthy mom is the best gift you can give your baby.
Is verapamil safe while breastfeeding?
Yes, verapamil is generally considered safe for breastfeeding mothers. Studies show only trace amounts pass into breast milk-less than 1% of the mother’s dose. Major health organizations, including the NHS and WHO, classify it as compatible with lactation. Most babies show no side effects.
Can verapamil cause my baby to have a slow heart rate?
It’s extremely rare. The amount of verapamil in breast milk is too low to affect a healthy baby’s heart rate. However, if your baby was born prematurely or already has a heart condition, talk to your pediatrician. They may want to monitor heart rhythm during the first few weeks.
Should I stop breastfeeding if I start verapamil?
No. Stopping breastfeeding is rarely necessary. The benefits of breast milk-including infection protection and long-term health advantages-far outweigh the minimal risk from verapamil. Most mothers continue without issue. Only stop if your baby shows clear signs of reaction, like extreme drowsiness or poor feeding.
When is the best time to take verapamil while breastfeeding?
Take your dose right after a feeding session. Verapamil peaks in your blood 2-3 hours after taking it, which means that’s when the most enters your milk. Taking it after nursing gives your body time to clear the drug before the next feed, reducing your baby’s exposure.
Are there safer alternatives to verapamil for breastfeeding mothers?
Labetalol and metoprolol are often preferred for high blood pressure because they transfer even less into breast milk. For heart rhythm issues, propranolol is another option. But if verapamil is the only drug that effectively controls your condition, switching isn’t always safer. Stability in your treatment matters more than a small theoretical benefit.
Can verapamil affect my milk supply?
There’s no evidence that verapamil reduces milk production. Unlike some blood pressure drugs (like older beta-blockers), it doesn’t interfere with prolactin, the hormone that drives milk supply. If your supply drops, it’s more likely due to stress, sleep deprivation, or missed feeds-not the medication.
Should I test my baby’s blood for verapamil levels?
No. Blood tests aren’t needed or recommended. The amount of verapamil in breast milk is too low to be clinically meaningful. Testing would be expensive, stressful, and won’t change your care plan. Watch for symptoms instead-most babies show no signs at all.
Does verapamil cause drowsiness in babies?
Very rarely. A few case reports mention slightly increased sleepiness, but this usually resolves on its own. If your baby seems unusually sleepy, difficult to wake for feeds, or lethargic, contact your pediatrician. But this is not a common side effect and doesn’t mean you need to stop breastfeeding.
Scott Dill
Just found this post and holy crap, this is exactly what I needed. I’ve been on verapamil for 8 months postpartum and was terrified I was hurting my 6-month-old. Now I feel way better knowing the numbers are so tiny.