Summary of Use during Lactation

Milk levels after the lowest dose of the combination of valsartan and sacubitril (Entresto) are very low. If the highest recommended maternal dosage (6 times greater) produces proportionate milk levels, they would likely still be quite low. Valsartan is unlikely to affect the nursing infant.

Drug Levels

Maternal Levels. Five mothers taking sacubitril 24 mg and valsartan 26 mg (Entresto) twice daily collected milk samples at 0,1, 2, 4, 6, 8, 10, and 12 hours after taking a dose at steady state. Sacubitril and its active metabolite, LBQ657, were found in the samples, but valsartan was undetectable (<0.19 mcg/L) in all milk samples.[1]

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Two women taking sacubitril 24 mg and valsartan 26 mg (Entresto) did not observe any symptoms in their breastfed infants. Their extent of breastfeeding was not reported.[1]

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

Alternate Drugs to Consider

Candesartan, Captopril, Benazepril, Enalapril, Quinapril

References

1.

Falconi S, Okimi A, Wesley S, et al. The concentration of maternal sacubitril/valsartan transferred into human milk is negligible. Front Public Health 2024;12:1389513 [PMC free article: PMC11150817] [PubMed: 38841677]

Substance Name

Valsartan

CAS Registry Number

137862-53-4

Drug Class

Breast Feeding

Lactation

Milk, Human

Antihypertensive Agents

Angiotensin II Type 1 Receptor Blockers

Angiotensin Receptor Blockers

ARBs