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Dosing & administration
Dosing varies by indication and patient profile. Always follow your institution's current prescribing guidelines.
Renal impairment
Consult protocols for adjustment.
Liver impairment
Consult protocols for adjustment.
Use during pregnancy
1st trimester
Avoid. Discontinue as soon as pregnancy is confirmed. Some data suggest cardiac defect risk similar to ACE inhibitors.
2nd trimester
Contraindicated. High risk of oligohydramnios and fetal renal injury.
3rd trimester
Contraindicated. High risk of fetal/neonatal death, renal failure, and pulmonary hypoplasia.
Clinical note
Contraindicated throughout pregnancy. ARBs carry the same fetopathic mechanism as ACE inhibitors: inhibition of the renin-angiotensin system (RAS) disrupts fetal renal development. Second and third trimester exposure causes fetal renal tubular dysgenesis, oligohydramnios, skull hypoplasia, limb contractures, and fetal/neonatal death. First-trimester risk for cardiac defects has been reported. Discontinue immediately upon confirmed pregnancy.
Breastfeeding
Use with caution. Excreted in breast milk in limited amounts; safer alternatives preferred for postpartum hypertension.
