valsartan

valsartan /val·sar·tan/ (-sahr´tan) an angiotensin II antagonist used as an antihypertensive.

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val·sar·tan (vl-särtn)

n.

An oral drug that is an angiotensin II receptor antagonist, used to treat hypertension.

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valsartan,

an antihypertensive.

indications It is used to treat hypertension, either alone or in combination with other agents.

contraindications Factors that prohibit its use are known hypersensitivity to valsartan, pregnancy, severe hepatic disease, and bilateral renal artery stenosis.

adverse effects Life-threatening effects are cerebrovascular accident, myocardial infarction, hepatotoxicity, and nephrotoxicity. Other adverse effects are depression, drowsiness, vertigo, angina pectoris, second-degree atrioventricular block, hypotension, conjunctivitis, abdominal pain, nausea, impotence, neutropenia, cramps, myalgia, musculoskeletal pain, and stiffness. Common side effects are dizziness, insomnia, arrhythmias, diarrhea, anemia, and cough.

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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.