Diovan

Di·o·van (d-vn)

A trademark for the drug valsartan.

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valsartan

Diovan

Pharmacologic class: Angiotensin II receptor antagonist

Therapeutic class: Antihypertensive

Pregnancy risk category C (first trimester), D (second and third trimesters)

FDA Boxed Warning

• When used during second or third trimester of pregnancy, drug may cause fetal harm or death. Discontinue as soon as pregnancy is detected.

Action

Blocks the vasoconstrictive and aldosterone-producing effects of angiotensin II at various receptor sites, including vascular smooth muscle and adrenal glands

Availability

Tablets: 40 mg, 80 mg, 160 mg, 320 mg

⊘Indications and dosages

➣ Hypertension

Adults: Initially, 80 to 160 mg P.O. daily. May increase as needed to a maximum of 320 mg P.O. daily, or a diuretic may be added.

➣ Heart failure

Adults: 40 mg P.O. b.i.d., titrated to 80 mg or 160 mg P.O. b.i.d., as tolerated

➣ Reduction of cardiovascular mortality in clinically stable patients with left ventricular failure or left ventricular dysfunction following myocardial infarction

Adults: 20 mg P.O. b.i.d., followed by titration to 40 mg P.O. b.i.d., with subsequent titration to a target maintenance dosage of 160 mg P.O. b.i.d., as tolerated

Dosage adjustment

• Symptomatic hypotension
• Renal dysfunction

Off-label uses

• Left ventricular hypertrophy
• Diabetic nephropathy

Contraindications

• Hypersensitivity to drug or its components
• Second or third trimester of pregnancy

Precautions

Use cautiously in:
• severe heart failure; volume or sodium depletion; hepatic or renal impairment; obstructive biliary disorders; angioedema; aortic, mitral valve, or renal artery stenosis; hyperkalemia
• concurrent use of high-dose diuretics
• black patients
• females of childbearing age
• pregnant patients in first trimester
• children younger than age 18 (safety not established).

Administration

• Give with or without food.

Route	Onset	Peak	Duration
P.O.	Within 2 hr	4-6 hr	24 hr

Adverse reactions

CNS: dizziness, fatigue, headache

CV: hypotension, palpitations

EENT: sinus disorders

GI: nausea, diarrhea, constipation, abdominal pain, dry mouth

GU: albuminuria, renal impairment

Hematologic: neutropenia

Metabolic: hyperkalemia

Musculoskeletal: back pain, joint pain, muscle cramps

Skin: alopecia, angioedema

Other: dental pain, fever, viral infection

Interactions

Drug-drug. Other antihypertensives: increased risk of hypotension

Potassium-sparing diuretics, potassium supplements: increased risk of hyperkalemia

Drug-diagnostic tests. Urine albumin, urine potassium: increased levels

Drug-food. Salt substitutes containing potassium: increased risk of hyperkalemia

Drug-herbs. Ephedra (ma huang): reduced hypotensive effect of valsartan

Drug-behaviors. Alcohol use: increased CNS depression

Patient monitoring

• Monitor blood pressure closely, especially during initial therapy and dosage adjustments.
• Assess potassium level. Stay alert for hyperkalemia.
• Be aware that in black patients, drug may be ineffective when used alone. Additional agents may be required.

Patient teaching

• Tell patient he may take with or without food.
☞ Instruct female of childbearing age to report pregnancy immediately.
• Advise patient to avoid potassium-containing salt substitutes.
• Caution patient to avoid alcohol.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.