ACE Inhibitors Reconsidered

2

March 19, 2017 by Leah

After I decided to go ahead and quit breastfeeding so I could go on ACE inhibitors, I posted on a local breastmilk exchange board in case anyone had extra milk she was looking to get rid of. A 2014 Georgetown medical school grad nosed in and mentioned that she’d had patients who breastfed with no ill effects while taking ACE inhibitors and statins, and pointed me toward the Infant Risk Center at Texas Tech University.

I got really excited about the idea that I might be able to swap out blood pressure drugs from one that causes fatigue and depression to one that generally improves patients’ feelings of wellbeing and, is, apparently, my “best hope” of prolonging my native kidney function.

The weird part is that ACE inhibitors are known for impairing renal function and causing hyperkalemia, or high blood potassium. I already have elevated blood potassium, since my kidneys aren’t processing potassium well, which is why I’m on this kidney diet. Hyperkalemia freaks me out because it can cause issues with muscles up to and including heart attacks. I am really afraid of having a heart attack and it is beginning to look like a heart attack is what will carry me off, and probably before my time, since heart attacks and strokes tend to be what kills kidney patients (and women in general, but I thought I had more time before I started worrying in earnest about death).

So I emailed my nephrologist and said, hey, look at this data, can we try starting me on Enalapril (an ACE inhibitor that has been studied) without me weaning the baby? And he called and said he was uncomfortable with this plan, but he had talked to my OB’s partner who had heard of this being done in some rare cases, and that we could try it once he talks to our pediatrician and if I sign informed consent. But then he explained he would want me to take the ACE inhibitors in addition to the beta blocker that I’m on (the one I was hoping to ditch because of side effects), and that I would need weekly blood tests because of the side effects of renal impairment and hyperkalemia, and that if my kidney function or potassium levels showed any indication of getting worse, we would start diuretics and potassium binders right away, neither of which are breastfeeding-compatible.

That was a really disappointing conversation. I spent a couple of days being really depressed about it, actually. I’m on four meds, adding an ACE inhibitor would probably actually lead to adding two other drugs on top of that, and I think the doctor still wants me on statins and the fancy drug for hypoparathyroidism as well. All of which would put me up to nine drugs. (Have I mentioned I’ve already blown through our HSA for this calendar year and it’s only March?) No, thanks.

Anyway, I emailed my doctor and said I wanted to wait until my next round of labs comes back before making changes, but that I’d be willing to try something different at that point (early May). He emailed back and said that the more he read and talked to people, the more he thought my plan was a solid one that we should try.

So, starting in May, I’ll attempt to switch over to ACE inhibitors and see if they really do shut down my kidney function even further, while somehow also protecting it (HOW? I just do not get this?!). Even after the emotional rollercoaster, I was delighted to discover that my physician was open to changing his opinion when presented with new evidence. I wish more people could do that.