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Angiotensin receptor blockers (ARBs) and pregnancy and breastfeeding

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

ACE inhibitors and angiotensin II receptor antagonists (A2RAs) (angiotensin receptor blockers (ARBs)) use during breastfeeding

  • ACE inhibitors and A2RAs (ARBs) should not be used at any stage of pregnancy, as exposure during pregnancy has been associated with adverse kidney effects and other congenital anomalies

  • ACE inhibitors and A2RAs (ARBs) should not be used by breastfeeding mothers in the first few weeks after delivery because of possible profound neonatal hypotension; preterm babies may be at particular risk

  • in mothers who are breastfeeding older infants, the use of captopril, enalapril, or quinapril may be considered, although careful follow-up of the infant for possible signs of hypotension is recommended (1)

A review by the NHS Specialist Pharmacy Service noted with respect to use of A2RAs (ARBs) during breastfeeding (2):

  • there is almost no published evidence of the use of any medicine in this class during breastfeeding
  • if there are no other therapeutic options, angiotensin-II receptor antagonists (ARBs) can be used with caution during breastfeeding
    • candesartan, losartan or valsartan have the most favourable pharmacokinetics and would therefore be preferred
      • however, given the very limited published evidence it would usually be preferable to choose a medicine from a different class which has more information supporting their use in breastfeeding
    • infants at most risk of side-effects
      • neonates and infants less than 2 months are at the most risk from the side-effects of angiotensin-II receptor antagonists, particularly hypotension, because they have underdeveloped clearance capacities, which means they can’t metabolise the medicines as effectively
      • in addition, there is theoretical concern that angiotensin-II receptor antagonists could affect kidney development. However, this has not been proven
      • if an angiotensin-II receptor antagonists is the best therapeutic option, extra caution should be taken when breastfeeding younger infants and neonates


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