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Pharmacologic class: Angiotensin II receptor antagonist
Therapeutic class: Antihypertensive
Pregnancy risk category C (first trimester), D (second and third trimesters)
Blocks the vasoconstrictive and aldosterone-producing effects of angiotensin II at various receptor sites, including vascular smooth muscle and adrenal glands
Tablets: 40 mg, 80 mg, 160 mg, 320 mg
Indications and dosages
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.
Children ages 6 to 16: Initially, 1.3 mg/kg (up to 40 mg total) P.O. once daily; dosage range is 1.3 to 2.7 mg/kg (40 to 160 mg total).
➣ 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
• Symptomatic hypotension
• Renal dysfunction
• Left ventricular hypertrophy
• Diabetic nephropathy
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, hypotension
• pregnant or breastfeeding patients
• children younger than age 6 (safety not established).
• Give with or without food.
• For children who can't swallow tablets or children for whom calculated dosage doesn't correspond to available tablet strength, use a suspension but be aware that exposure to the suspension is 1.6 times greater than the tablet.
• To prepare 160 ml of a 4-mg/ml suspension, add 80 ml of Ora-Plus to bottle containing eight valsartan 80-mg tablets and shake for at least 2 minutes. Allow suspension to stand for at least 1 hour. Then shake for at least 1 additional minute. Add 80 ml of Ora-Sweet to bottle and shake for at least 10 seconds before giving appropriate dose. May store suspension for 30 days at room temperature or up to 75 days if refrigerated.
Be aware that drug isn't recommended for children with glomerular filtration rate of less than 30 ml/minute/1.732.
CNS: dizziness, fatigue, headache
CV: hypotension, palpitations
EENT: sinus disorders, rhinitis, pharyngitis
GI: nausea, diarrhea, constipation, abdominal pain, dry mouth
GU: albuminuria, renal impairment
Musculoskeletal: back pain, joint pain, muscle cramps
Respiratory: cough, upper respiratory tract infection
Skin: alopecia, angioedema
Other: dental pain, fever, viral infection, edema
Drug-drug. Nonsteroidal anti-inflammatory drugs including selective cyclooxygenase-2 inhibitors: increased risk of renal impairment including acute renal failure in elderly patients, volume-depleted patients, or those with compromised renal function; loss of valsartan antihypertensive effect
Other antihypertensives: increased risk of hypotension
Potassium-sparing diuretics, potassium supplements: increased risk of hyperkalemia
Drug-diagnostic tests. Serum creatinine, serum and 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
• 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.
• Tell patient he may take with or without food.
• For children who can't swallow tablets or children for whom calculated dosage doesn't correspond to available tablet strength, show caregiver how to prepare a suspension.
Instruct female of childbearing age to report pregnancy immediately.
• Advise breastfeeding patient to avoid breastfeeding while taking drug.
• 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.
Pharmacologic: angiotensin ii receptor antagonists
Time/action profile (antihypertensive effect)
|PO||within 2 hr*||4 wks†||24 hr†|
Adverse Reactions/Side Effects
Central nervous system
- dizziness (most frequent)
Ear, Eye, Nose, Throat
Fluid and Electrolyte
- abdominal pain
- impaired renal function
- back pain
- angioedema (life-threatening)
Drug-Drug interactionAdditive hypotension with other antihypertensives.Excessive hypotension may occur with concurrent use of diuretics.↑ risk of hyperkalemia with concurrent use of potassium supplements, potassium-containing salt substitutes, or potassium-sparing diuretics.↑ risk of hyperkalemia, renal dysfunction, hypotension, and syncope with concurrent use of ACE inhibitors or aliskiren ; avoid concurrent use with aliskiren in patients with diabetes or CCr <60 mL/minNSAIDs and selective COX-2 inhibitors may blunt the antihypertensive effect and ↑ the risk of renal dysfunction.
- Assess BP (lying, sitting, standing) and pulse frequently during initial dosage adjustment and periodically throughout therapy. Notify health care professional of significant changes.
- Monitor frequency of prescription refills to determine compliance.
- Assess patients for signs of angioedema (dyspnea, facial swelling).
- HF: Monitor daily weight and assess patient routinely for resolution of fluid overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention).
- Lab Test Considerations: Monitor renal function. May cause increase in BUN and serum creatinine.
- May cause hyperkalemia.
- May cause ↑ AST and ALT.
- May cause slight ↓ in hemoglobin and hematocrit, or neutropenia.
Potential Nursing DiagnosesRisk for injury (Adverse Reactions)
Noncompliance (Patient/Family Teaching)
- Do not confuse Diovan with Zyban.
- Volume depletion should be corrected, if possible, before initiation of therapy.
- Oral: May be taken without regard to food.
- Emphasize the importance of continuing to take as directed, at the same time each day, even if feeling well. Take missed doses as soon as remembered if not almost time for next dose; do not double doses. Warn patient not to discontinue therapy unless directed by health care professional.
- Caution patient to avoid salt substitutes containing potassium or foods containing high levels of potassium or sodium unless directed by health care professional. See.
- Caution patient to avoid sudden position changes to decrease orthostatic hypotension. Use of alcohol, standing for long periods, exercising, and hot weather may increase orthostatic hypotension.
- May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to avoid concurrent use of Rx, OTC, and herbal products, especially NSAIDs and cough, cold, or allergy medications, without consulting health care professional.
- Instruct patient to notify health care professional of medication regimen before treatment or surgery.
- Instruct patient to notify health care professional if swelling of face, eyes, lips, or tongue or if difficulty swallowing or breathing occur.
- Advise women of childbearing age to use contraception and notify health care professional if pregnancy is planned or suspected, or if breastfeeding. Valsartan should be discontinued as soon as possible when pregnancy is detected.
- Emphasize the importance of follow-up exams to evaluate effectiveness of medication.
- Hypertension: Encourage patient to comply with additional interventions for hypertension (weight reduction, low-sodium diet, discontinuation of smoking, moderation of alcohol consumption, regular exercise, stress management). Medication controls but does not cure hypertension.
- Instruct patient and family on proper technique for monitoring BP. Advise them to check BP at least weekly and to report significant changes.
- Decrease in BP without appearance of excessive side effects. Effects are usually seen within 2 wks, with maximum effect in 4 wks.
- Decreased heart-failure-related hospitalizations in patients with heart failure.
- Decreased risk of death from cardiovascular causes in patients with left ventricular systolic dysfunction following myocardial infarction.