Telmisartan Should Not Be Given to Nursing Mothers
Telmisartan is contraindicated during breastfeeding due to the potential for serious adverse reactions in the nursing infant, including hypotension, hyperkalemia, and renal impairment. 1
Primary Recommendation
The FDA drug label explicitly advises nursing women not to breastfeed during treatment with telmisartan. 1 This recommendation is based on:
Lack of human safety data: There is no information regarding the presence of telmisartan in human milk, its effects on the breastfed infant, or its effects on milk production. 1
Animal data showing drug transfer: Telmisartan was present in the milk of lactating rats at concentrations 1.5 to 2 times those found in plasma from 4 to 8 hours after administration. 1
Serious potential adverse effects: The drug class (ARBs) can cause hypotension, hyperkalemia, and renal impairment in exposed infants. 1
Guideline-Based Evidence
ACE inhibitors and ARBs (including telmisartan) should be avoided during lactation based on reports of adverse fetal and neonatal renal effects. 2 The JNC 7 guidelines specifically state that ACEIs and ARBs should be avoided in nursing mothers on the basis of reports of adverse fetal and neonatal renal effects. 2
Alternative Antihypertensive Options for Nursing Mothers
If blood pressure control is needed during lactation, safer alternatives include:
Methyldopa: No short-term adverse effects have been reported from exposure in breastfed infants. 2
Hydralazine: No short-term adverse effects have been reported from exposure in breastfed infants. 2
Propranolol or labetalol: These are preferred beta-blockers if this drug class is indicated. 2
Nifedipine: Considered safe for breastfeeding mothers. 2
Enalapril and metoprolol: Also considered safe for breastfeeding mothers. 2
Clinical Context for Stage 1 Hypertension
For mothers with stage 1 hypertension who wish to breastfeed for a few months, it may be prudent to withhold antihypertensive medication entirely, with close monitoring of blood pressure, and reinstitute therapy following discontinuation of nursing. 2 This approach balances the benefits of breastfeeding against the risks of medication exposure.
Important Caveats
All antihypertensive drugs studied are excreted into human breast milk. 2
Breastfed infants of mothers taking any antihypertensive agents should be closely monitored for potential adverse effects. 2
Diuretics may reduce milk volume and suppress lactation, making them less desirable during breastfeeding. 2
Documented Case Reports
A case report documented neonatal transient renal failure following telmisartan therapy during pregnancy, reinforcing that this class of antihypertensive drugs should be avoided during pregnancy and breastfeeding. 3