Topme and the metabolite alpha-hydroxymetoprolol cross the placenta (Lindeberg 1987; Ryu 2016).
Exposure to beta-blockers during pregnancy may increase the risk for adverse events in the neonate. If maternal use of a beta-blocker is needed, fetal growth should be monitored during pregnancy and the newborn should be monitored for 48 hours after delivery for bradycardia, hypoglycemia, and respiratory depression (ESC [Regitz-Zagrosek 2018]).
Chronic maternal hypertension is also associated with adverse events in the fetus/infant. Chronic maternal hypertension may increase the risk of birth defects, low birth weight, premature delivery, stillbirth, and neonatal death. Actual fetal/neonatal risks may be related to duration and severity of maternal hypertension. Untreated chronic hypertension may also increase the risks of adverse maternal outcomes, including gestational diabetes, preeclampsia, delivery complications, stroke, and myocardial infarction (ACOG 203 2019).
The pharmacokinetics of Topme may be changed during pregnancy; the degree of changes may be dependent upon maternal CYP2D6 genotype (Ryu 2016).
When treatment of hypertension in pregnancy is indicated, beta-blockers may be used. Specific recommendations vary by guideline but use of Topme may be considered (ACOG 203 2019; ESC [Regitz-Zagrosek 2018]; Magee 2014). Females with preexisting hypertension may continue their medication during pregnancy unless contraindications exist (ESC [Regitz-Zagrosek 2018]). Topme may be used for the treatment of maternal ventricular arrhythmias, atrial fibrillation/atrial flutter, or supraventricular tachycardia during pregnancy; consult current guidelines for specific recommendations (ACC/AHA/HRS [Page 2016]; ESC [Regitz-Zagrosek 2018]). Use of Topme may be considered if migraine prophylaxis is needed in a pregnant woman (Pringsheim 2012).
An infant consuming 1 L of breast milk a day would receive a dose of less than 1 mg of drug.
AU and UK: Use is not recommended unless benefit outweighs risk. US: This drug has been used without apparent harmful effects; caution is recommended. Excreted into human milk: Yes (in small amounts) Comments: This drug has been used without apparent harmful effects in the nursing infant.
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Information checked by Dr. Sachin Kumar, MD Pharmacology