Valsartan

1. Introduction

Valsartan is an angiotensin II receptor blocker (ARB) used primarily for hypertension, heart failure, and post-myocardial infarction (MI) management. It works by blocking the angiotensin II receptor, leading to vasodilation, reduced blood pressure, and decreased cardiac workload.

2. Indications

  • Hypertension (High Blood Pressure)
  • Heart Failure (NYHA Class II–IV)
  • Post-Myocardial Infarction (MI) to Reduce Mortality & Improve Left Ventricular Function
  • Diabetic Nephropathy (Off-Label Use)

3. Dosage

Adults:

  • Hypertension:
    • Starting dose: 80 mg once daily
    • Maintenance dose: 80–160 mg once daily
    • Max dose: 320 mg/day
  • Heart Failure:
    • Starting dose: 40 mg twice daily
    • Target dose: 160 mg twice daily
  • Post-Myocardial Infarction:
    • Starting dose: 20 mg twice daily
    • Maintenance dose: 160 mg twice daily

Children (Hypertension Only):

  • 6–16 years: 1.3 mg/kg once daily (max 160 mg/day).
  • >16 years: Use adult dosing.

Elderly:

  • No dose adjustment needed but monitor renal function.

Renal Impairment:

  • Mild to moderate impairment (CrCl >30 mL/min): No dose adjustment.
  • Severe impairment (CrCl <30 mL/min): Use with caution.

Hepatic Impairment:

  • Mild-moderate impairment: Max 80 mg daily.
  • Severe hepatic impairment: Avoid use.

4. Administration

  • Take with or without food.
  • Swallow whole with water.
  • If taking twice daily, space doses evenly.
  • Do not stop suddenly, as it may cause a spike in blood pressure.

5. Forms Available

  • Tablets: 40 mg, 80 mg, 160 mg, 320 mg
  • Oral Suspension (for paediatrics, some regions)

6. Side Effects

6.1 Common Side Effects:

  • Dizziness
  • Fatigue
  • Hypotension
  • Hyperkalaemia (high potassium levels)

6.2 Less Common Side Effects:

  • Cough (less common than with ACE inhibitors)
  • Headache
  • Muscle cramps

6.3 Rare but Serious Side Effects:

  • Angioedema (swelling of face, lips, tongue)
  • Severe hypotension
  • Renal impairment / acute kidney injury (AKI)
  • Hepatotoxicity (very rare but possible)

7. Warnings

  • Hyperkalaemia Risk: Avoid excessive potassium intake and monitor serum potassium.
  • Renal Dysfunction: Monitor kidney function, especially in heart failure patients.
  • Avoid in Pregnancy: Risk of fetal harm—contraindicated in 2nd and 3rd trimesters.
  • Hypotension Risk: Can cause excessive BP drop, especially in dehydrated patients.

8. Precautions

  • Monitor renal function & potassium regularly, especially in patients on diuretics, ACE inhibitors, or NSAIDs.
  • Caution in patients with bilateral renal artery stenosis, as valsartan can worsen renal function.
  • Not first-line for black patients with hypertension—less effective unless combined with a diuretic.

9. Interactions

  • ACE Inhibitors (e.g., Ramipril): Increased risk of renal impairment and hyperkalaemia.
  • NSAIDs (e.g., ibuprofen, naproxen): May reduce antihypertensive effect and worsen kidney function.
  • Potassium-Sparing Diuretics (e.g., spironolactone): Increased risk of hyperkalaemia.
  • Lithium: Increased risk of lithium toxicity.

10. Monitoring Parameters

  • Blood pressure (BP): Every 2–4 weeks initially, then as needed.
  • Renal function (eGFR, creatinine): At baseline, then every 3–6 months.
  • Serum potassium: Especially in renal disease or if taking potassium supplements.

11. Use in Children

  • Approved for hypertension in children aged 6+ years.
  • Not recommended in infants (<6 years).

12. Use in Pregnancy

  • Category D:
    • Contraindicated in the 2nd and 3rd trimester due to risk of fetal kidney damage, oligohydramnios, and fetal death.
    • Alternative antihypertensives (e.g., labetalol, nifedipine) preferred in pregnancy.

13. Use in Elderly

  • Safe, but start at lower doses if frail.
  • Monitor renal function and potassium levels closely.

14. Use in Kidney Disease

  • Mild-moderate renal impairment: No dose adjustment.
  • Severe renal disease (CrCl <30 mL/min): Use with caution.
  • End-stage renal disease (ESRD): Avoid or use with close monitoring.

15. Use in Liver Disease

  • Mild to moderate hepatic impairment: Max dose 80 mg/day.
  • Severe hepatic impairment: Avoid use.

16. Patient Counselling Points

  • Take at the same time daily for best effect.
  • Do not stop suddenly, as it may cause BP spikes or heart failure worsening.
  • Monitor blood pressure at home and report very low readings (<90/60 mmHg).
  • Avoid potassium supplements & high-potassium foods (bananas, oranges, leafy greens) unless advised by a doctor.
  • Report swelling of the face or lips (angioedema) immediately.

17. Table of Brand Names, Manufacturer, and Prices in USD

Brand NameManufacturerStrength/Dosage FormPrice (USD)
DiovanNovartis80 mg, 160 mg, 320 mg Tablets$120 (30 tabs)
Generic ValsartanVarious40 mg, 80 mg, 160 mg Tablets$40 (30 tabs)
Exforge (Valsartan + Amlodipine)Novartis5/160 mg, 10/160 mg Tablets$150 (30 tabs)

18. 15 FAQs (Frequently Asked Questions)

1. What is Valsartan used for?
It is used for hypertension, heart failure, and post-MI protection.

2. How does Valsartan work?
It blocks angiotensin II receptors, causing vasodilation and reduced blood pressure.

3. How long does Valsartan take to work?
Blood pressure starts lowering within 2 weeks, full effect in 4 weeks.

4. Can I take Valsartan with food?
Yes, it can be taken with or without food.

5. Can Valsartan cause weight gain?
No, weight gain is not a known side effect.

6. Can I stop Valsartan suddenly?
No, stopping suddenly can cause rebound hypertension.

7. Does Valsartan cause coughing?
No, unlike ACE inhibitors, cough is rare with ARBs.

8. Can Valsartan cause kidney problems?
Yes, especially in severe renal impairment.

9. Can I take Valsartan with ibuprofen?
Occasionally, but long-term NSAID use may reduce its effectiveness.

10. Can I take Valsartan at night?
Yes, taking at night may improve BP control in some patients.

11. Is Valsartan safe in diabetes?
Yes, it can protect kidney function in diabetic nephropathy.

12. Can I drink alcohol with Valsartan?
Limit alcohol, as it may increase dizziness and low BP.

13. Is Valsartan safe in pregnancy?
No, it is contraindicated in pregnancy.

14. Does Valsartan affect heart rate?
No, it does not directly lower heart rate.

15. How should Valsartan be stored?
Store at room temperature, away from moisture.