Valsartan

What is Valsartan

Valsartan is a specific angiotensin II antagonist which selectively and competitively blocks the AT1 receptor, which mediates the vasopressor and aldosterone effects of angiotensin II.

Unlike losartan, valsartan does not have an active metabolite or possess uricosuric effects. Valsartan is used to treatment hypertension in adults and children >= 6 years of age; it is also FDA-approved to treat heart failure in patients who are intolerant to ACE inhibitors.

Because valsartan does not inhibit angiotensin converting enzyme (ACE), it does not result in bradykinin accumulation which is theorized to cause the cough and angioedema associated with ACE inhibitors.

However, angioedema has been rarely associated with valsartan or other angiotensin II antagonists. Valsartan is effective for hypertension, either alone or in combination with other antihypertensive agents. Because AT1 receptors are nearly saturated at the starting dose for most angiotensin II antagonists, the antihypertensive dose-response curve of these drugs are nonlinear, with proportionally small decreases in blood pressure attained with increased dosage. Greater antihypertensive efficacy is achieved by adding a small dose of a diuretic to the angiotensin II antagonist.

Modest reduction in blood pressure is achieved by increasing the dose of valsartan over the dosage range of 80—320 mg. Valsartan reduces left ventricular hypertrophy (LVH), although the clinical benefit associated with reducing LVH is not well established.

Limited data show that valsartan also reduces proteinuria in patients with hypertension and renal disease; however, larger clinical trials are needed to evaluate the comparative renoprotective efficacy and long-term benefits of valsartan versus ACE inhibitors in patients with renal disease or nephropathy. In addition to antihypertensive actions, the angiotensin II antagonists have been effective in the treatment of heart failure.

Another angiotensin receptor antagonist, losartan, has been shown to lower all-cause mortality and hospitalization to a greater extent than captopril in elderly patients with chronic CHF.

Brand Name

Diovan

Indications

  • heart failure
  • hypertension
  • reduction of cardiovascular mortality
  • Valsartan oral solution (Prexxartan) is not therapeutically equivalent to the tablet formulation (Diovan)

Side Effects

  1. abdominal pain
  2. alopecia
  3. anaphylactoid reactions
  4. anemia
  5. angioedema
  6. anorexia
  7. anxiety
  8. arthralgia
  9. asthenia
  10. azotemia
  11. back pain
  12. blurred vision
  13. bullous rash
  14. chest pain (unspecified)
  15. constipation
  16. cough
  17. diarrhea
  18. dizziness
  19. drowsiness
  20. dyspepsia
  21. dyspnea
  22. edema
  23. elevated hepatic enzymes
  24. fatigue
  25. flatulence
  26. headache
  27. hepatitis
  28. hyperkalemia
  29. hypotension
  30. impotence (erectile dysfunction)
  31. insomnia
  32. muscle cramps
  33. myalgia
  34. nausea
  35. neutropenia
  36. oliguria
  37. orthostatic hypotension
  38. palpitations
  39. paresthesias
  40. pharyngitis
  41. pruritus
  42. rash
  43. renal failure (unspecified)
  44. rhabdomyolysis
  45. rhinitis
  46. sinusitis
  47. syncope
  48. teratogenesis
  49. thrombocytopenia
  50. vasculitis
  51. vertigo
  52. vomiting
  53. xerostomia

Monitoring Parameters

  • blood pressure
  • LFTs
  • serum bilirubin (total and direct)

Contraindications

  • ACE-inhibitor induced angioedema
  • angioedema
  • Black patients
  • breast-feeding
  • children
  • geriatric
  • heart failure
  • hepatic disease
  • hyperkalemia
  • hypotension
  • hypovolemia
  • infants
  • neonates
  • pregnancy
  • renal artery stenosis
  • renal failure
  • renal impairment
  • surgery

Interactions

  • Acarbose
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Guaifenesin; Phenylephrine
  • Acetaminophen; Pseudoephedrine
  • Acrivastine; Pseudoephedrine
  • Aldesleukin, IL-2
  • Alemtuzumab
  • Aliskiren
  • Aliskiren; Amlodipine
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Aliskiren; Hydrochlorothiazide, HCTZ
  • Aliskiren; Valsartan
  • Alogliptin; Metformin
  • Alpha-glucosidase Inhibitors
  • Alprostadil
  • Amifostine
  • Amiloride
  • Amiloride; Hydrochlorothiazide, HCTZ
  • Amobarbital
  • Amphetamine; Dextroamphetamine Salts
  • Amyl Nitrite
  • Angiotensin II
  • Angiotensin-converting enzyme inhibitors
  • Apomorphine
  • Apraclonidine
  • Aprepitant, Fosaprepitant
  • Aripiprazole
  • Asenapine
  • Atazanavir
  • Atazanavir; Cobicistat
  • Baclofen
  • Benzphetamine
  • Bosentan
  • Brexpiprazole
  • Brompheniramine; Carbetapentane; Phenylephrine
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Brompheniramine; Pseudoephedrine
  • Cabergoline
  • Calcium Phosphate, Supersaturated
  • Canagliflozin; Metformin
  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
  • Carbidopa; Levodopa
  • Carbidopa; Levodopa; Entacapone
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carbinoxamine; Phenylephrine
  • Carbinoxamine; Pseudoephedrine
  • Cariprazine
  • Cetirizine; Pseudoephedrine
  • Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
  • Chlophedianol; Guaifenesin; Phenylephrine
  • Chloroprocaine
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Clofarabine
  • Clozapine
  • Co-Enzyme Q10, Ubiquinone
  • Cobicistat
  • Cocaine
  • Codeine; Phenylephrine; Promethazine
  • Conivaptan
  • Cyclosporine
  • Daclatasvir
  • Dapagliflozin; Metformin
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Desloratadine; Pseudoephedrine
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dexmethylphenidate
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Guaifenesin; Phenylephrine
  • Dextromethorphan; Guaifenesin; Pseudoephedrine
  • Dextromethorphan; Quinidine
  • Diazoxide
  • Diethylpropion
  • Digoxin
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Phenylephrine
  • Drospirenone
  • Drospirenone; Estradiol
  • Drospirenone; Ethinyl Estradiol
  • Drospirenone; Ethinyl Estradiol; Levomefolate
  • Duloxetine
  • Elexacaftor; tezacaftor; ivacaftor
  • Eltrombopag
  • Elvitegravir
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Empagliflozin; Linagliptin; Metformin
  • Empagliflozin; Metformin
  • Enflurane
  • Ephedrine
  • Eplerenone
  • Epoprostenol
  • Ertugliflozin; Metformin
  • Estradiol
  • Estradiol Cypionate; Medroxyprogesterone
  • Etomidate
  • Fenofibric Acid
  • Fexofenadine; Pseudoephedrine
  • Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
  • Fluoxetine; Olanzapine
  • Fospropofol
  • Gemfibrozil
  • General anesthetics
  • Glipizide; Metformin
  • Glyburide; Metformin
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Guaifenesin; Phenylephrine
  • Guaifenesin; Pseudoephedrine
  • Haloperidol
  • Halothane
  • Heparin
  • Hydralazine; Isosorbide Dinitrate, ISDN
  • Hydrochlorothiazide, HCTZ; Spironolactone
  • Hydrochlorothiazide, HCTZ; Triamterene
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Ibuprofen; Pseudoephedrine
  • Iloperidone
  • Iloprost
  • Incretin Mimetics
  • Indapamide
  • Insulins
  • Intravenous Lipid Emulsions
  • Isocarboxazid
  • Isoflurane
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Isoproterenol
  • Isosorbide Dinitrate, ISDN
  • Isosorbide Mononitrate
  • Ketamine
  • Levodopa
  • Linagliptin; Metformin
  • Lisdexamfetamine
  • Lithium
  • Loop diuretics
  • Lopinavir; Ritonavir
  • Loratadine; Pseudoephedrine
  • Lovastatin; Niacin
  • Lurasidone
  • Magnesium Sulfate; Potassium Sulfate; Sodium Sulfate
  • Meglitinides
  • Mestranol; Norethindrone
  • Metformin
  • Metformin; Pioglitazone
  • Metformin; Repaglinide
  • Metformin; Rosiglitazone
  • Metformin; Saxagliptin
  • Metformin; Sitagliptin
  • Methamphetamine
  • Methohexital
  • Methylphenidate
  • Miglitol
  • Milrinone
  • Naproxen; Pseudoephedrine
  • Nateglinide
  • Nefazodone
  • Nesiritide, BNP
  • Niacin, Niacinamide
  • Niacin; Simvastatin
  • Nitrates
  • Nitroglycerin
  • Nitroprusside
  • Nonsteroidal antiinflammatory drugs
  • Obeticholic Acid
  • Olanzapine
  • Ombitasvir; Paritaprevir; Ritonavir
  • Oritavancin
  • Oxymetazoline
  • Paliperidone
  • Pentoxifylline
  • Phenelzine
  • Phenylephrine
  • Phenylephrine; Promethazine
  • Polyethylene Glycol; Electrolytes
  • Polyethylene Glycol; Electrolytes; Ascorbic Acid
  • Potassium
  • Pramlintide
  • Prazosin
  • Procainamide
  • Procaine
  • Propofol
  • Pseudoephedrine
  • Quinidine
  • Rasagiline
  • Repaglinide
  • Rifampin
  • Risperidone
  • Ritonavir
  • Selegiline
  • Sevoflurane
  • SGLT2 Inhibitors
  • Silodosin
  • Simeprevir
  • Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous
  • Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
  • Sofosbuvir; Velpatasvir; Voxilaprevir
  • Spironolactone
  • Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
  • Sulfonylureas
  • Telithromycin
  • Tetracaine
  • Thiazolidinediones
  • Thiopental
  • Thiothixene
  • Tizanidine
  • Tolvaptan
  • Tranylcypromine
  • Trazodone
  • Triamterene
  • Trimethoprim
  • Yohimbine
  • Zafirlukast
  • Ziprasidone
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