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Valsartan Pregnancy and Breastfeeding Warnings

Valsartan is also known as: Diovan, Prexxartan

Medically reviewed on November 23, 2016

Valsartan Pregnancy Warnings

Use during pregnancy is considered contraindicated.

AU TGA pregnancy category: D
US FDA pregnancy category: D

Comments:
-Adequate methods of contraception should be encouraged.
-Drugs acting directly on the renin-angiotensin system can cause fetal and neonatal morbidity and death when administered to pregnant women. If inadvertent exposure occurs during the second trimester, ultrasound examination of fetal renal function and skull is recommended. Women of childbearing potential should be advised of the potential hazards to the fetus and that valsartan should not be taken during pregnancy.

-Animal data have revealed evidence of fetotoxicity, but have failed to reveal evidence of teratogenicity. There are no controlled data in human pregnancy. Spontaneous abortion, oligohydramnios and newborn renal dysfunction have been reported when pregnant women inadvertently took valsartan.
-Valsartan is similar to angiotensin converting enzyme (ACE) inhibitors, which are contraindicated during pregnancy. Because of the many reports of fetal deaths and malformations associated with the use of ACE inhibitors, a committee of the National Institutes of Health has recommended that these drugs be avoided during pregnancy.
-The use of drugs that act directly on the RAA system during the second and third trimesters of pregnancy has been associated with fetal and neonatal injury, including hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death. Oligohydramnios has also been reported, presumably resulting from decreased fetal renal function; oligohydramnios in this setting has been associated with fetal limb contractures, craniofacial deformation, and hypoplastic lung development. Prematurity, intrauterine growth retardation, and patent ductus arteriosus have been reported, although it is not clear whether these occurrences were due to exposure to the drug.
-These adverse effects do not appear to have resulted from intrauterine drug exposure that has been limited to the first trimester. Mothers whose embryos and fetuses are exposed to an angiotensin II receptor antagonist only during the first trimester should be so informed. Nonetheless, when patients become pregnant, physicians should advise the patient to discontinue the use of valsartan as soon as possible.
-Rarely (probably less than once in every thousand pregnancies), no alternative to a drug acting on the RAA system will be found. In these rare cases, the mothers should be apprised of the potential hazards to their fetuses, and serial ultrasound examinations should be performed to assess the intra-amniotic environment.
-If oligohydramnios is observed, valsartan should be discontinued unless it is considered lifesaving for the mother. Contraction stress testing (CST), a nonstress test (NST), or biophysical profiling (BPP) may be appropriate, depending upon the week of pregnancy. Patients and physicians should be aware, however, that oligohydramnios may not appear until after the fetus has sustained irreversible injury.
-Infants with histories of in utero exposure to an angiotensin II receptor antagonist should be closely observed for hypotension, oliguria, and hyperkalemia. If oliguria occurs, attention should be directed toward support of blood pressure and renal perfusion. Exchange transfusion or dialysis may be required as means of reversing hypotension and/or substituting for disordered renal function.

AU TGA pregnancy category D: Drugs which have caused are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details.

US FDA pregnancy category D: There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

See references

Valsartan Breastfeeding Warnings

Use is not recommended and a decision should be made to discontinue breastfeeding or discontinue the drug, taking into account the importance of the drug to the mother.

Excreted into human milk: Unknown
Excreted into animal milk: Yes

Comments: The effects in the nursing infant are unknown.

See references

References for pregnancy information

  1. Cunniff C, Jones KL, Phiullipson J, Benirschke K, Short S, Wujek J "Oligohydramnios sequence and renal tubular malformation associated with maternal enalapril use." Am J Obstet Gynecol 162 (1990): 187-9
  2. "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals, East Hanover, NJ.
  3. Mehta N, Modi N "Ace inhibitors in pregnancy." Lancet 2 (1989): 96
  4. Cerner Multum, Inc. "Australian Product Information." O 0
  5. Royal Australian College of General Practicioners (RACGP), the Pharmaceutical Society of Australia (PSA), the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT) "Australian Medicines Handbook. Available from: URL: https://www.amh.net.au/"
  6. Shotan A, Widerhorn J, Hurst A, Elkayam U "Risks of angiotensin-converting enzyme inhibition during pregnancy: experimental and clinical evidence, potential mechanisms, and recommendations for use." Am J Med 96 (1994): 451-6
  7. Thorpe-Beeston JG, Armar NA, Dancy M, Cochrane GW, Ryan G, Rodeck CH "Pregnancy and ACE inhibitors." Br J Obstet Gynaecol 100 (1993): 692-3
  8. Smith AM "Are Ace inhibitors safe in pregnancy?" Lancet 2 (1989): 750-1
  9. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  10. Kreft-Jais C, Plouin PF, Tchobroutsky C "Angiotensin-converting enzyme inhibitors during pregnancy: a survey of 22 patients given captopril and nine given enalapril." Br J Obstet Gynaecol 95 (1988): 420-2
  11. Bos-Thompson MA, Hillaire-Buys D, Muller F, et al. "Fetal toxic effects of angiotensin II receptor antagonists: case report and follow-up after birth." Ann Pharmacother 39 (2004): 157-61
  12. Schubiger G, Flury G, Nussberger J "Enalapril for pregnancy-induced hypertension: acute renal failure in a neonate." Ann Intern Med 108 (1988): 215-6
  13. TGA. Therapeutic Goods Administration. Australian Drug Evaluation Committee "Prescribing medicines in pregnancy: an Australian categorisation of risk of drug use in pregancy. Available from: URL: http://www.tga.gov.au/docs/pdf/medpreg.pdf." ([1999]):

References for breastfeeding information

  1. "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals, East Hanover, NJ.
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. Royal Australian College of General Practicioners (RACGP), the Pharmaceutical Society of Australia (PSA), the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT) "Australian Medicines Handbook. Available from: URL: https://www.amh.net.au/"

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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