What to Know About Valsartan

Valsartan is a prescription drug classified as an angiotensin II receptor blocker (ARB). It’s used to treat high blood pressure and heart failure, and to improve survival after a heart attack. It is also used off-label to prevent kidney problems in people with diabetes.

Valsartan works by blocking an enzyme called angiotensin II that narrows blood vessels. Sold under the brand name Diovan, among others, valsartan is also available as a generic in tablet or oral suspension (liquid) form. It can be used in adults and children six and over.

Valsartan can be combined with other drugs to treat high blood pressure, like Co-Diovan (valsartan and hydrochlorothiazide) and Exforge (amlodipine and valsartan). Another combination drug that contains valsartan, Entresto (valsartan/sacubitril), is used in people with heart failure.

Uses

Valsartan was first licensed by the U.S. Food and Drug Administration (FDA) in 1996. It is FDA-approved for three uses:

• Treatment of hypertension (high blood pressure)
• Treatment of heart failure
• Reduction in the risk of death following a myocardial infarction (heart attack)

Valsartan and other ARBs are only used after a heart attack if the left ventricle ejection fraction (LVEF) is impaired. LVEF is the measure of the amount of blood propelled from the heart during a heartbeat.

The landmark VALIANT (Valsartan in Acute Myocardial Infarction) trial was the first to conclude that valsartan could effectively reduce the risk of death following a heart attack in people with reduced left ventricular function (a weak heat muscle). The trial found valsartan lowered this risk by roughly 19% compared to those not provided treatment.

Off-Label Uses

Valsartan is often used off-label to protect the kidneys of people with diabetes. Diabetes can cause a condition called diabetic nephropathy, where high blood glucose may damage the kidneys. This condition is characterized by proteinuria, or high protein levels in urine. 

In addition to lowering blood pressure, valsartan can reduce proteinuria, preserving kidney function and preventing the progression of diabetic nephropathy.

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Before Taking

Before prescribing valsartan, your healthcare provider will want to check for hypertension (blood pressure at or over 120 systolic and 80 diastolic) or heart failure, where the heart is unable to pump enough blood. 

Blood pressure is measured with a pressure cuff, while heart failure is typically diagnosed with tests like an electrocardiogram (EKG/ECG) and an exercise stress test.

With hypertension, treatment is usually started when blood pressure is:

• Systolic 120 and over/diastolic 80 and over for people with a history of heart disease

In those with a blood pressure between 121-129 systolic, and 80-89 diastolic, lifestyle interventions should be tried first, unless heart disease is present.

Treatment for heart failure is generally initiated when heart failure is:

• Symptomatic and limiting physical activity
• Class I or II according to the New York Heart Association Classification

Precautions and Contraindications

People with the following conditions should use valsartan with extreme caution:

• Impaired kidney function due to an increased risk of hyperkalemia and acute kidney failure
• Hypotension (low blood pressure), due to a potentially life-threatening drop in blood pressure
• Liver disease, due to an increased risk of hepatitis (liver inflammation)

If treatment is started, blood pressure, kidney function, and liver enzymes must be carefully monitored to avoid complications.

This drug should not be taken during pregnancy due to risk to the fetus.

Other ARBs

There are seven other FDA-approved ARBs:

• Atacand (candesartan)
• Avapro (irbesartan)
• Benicar (olmesartan)
• Cozaar (losartan)
• Edarbi (azilsartan)
• Micardis (telmisartan)
• Teveten (eprosartan)

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Dosage

Valsartan is available as a 40-milligram (mg), 80-mg, 160-mg, and 320-mg tablet. For children and people who can’t tolerate pills, there is also an oral suspension that delivers 4 mg of valsartan per 1-milliliter (mL) dose.

Valsartan is started at a lower dose and incrementally increased until an optimal dose is reached. These increases occur:

• Every two weeks for hypertension
• Every one to two weeks for heart failure
• Every week for a heart attack

Adults take fixed-dose pills; pediatric doses are calculated based on milligrams per kilogram (mg/kg) of body weight.

All listed dosages are according to the drug manufacturer. Check your prescription and talk to your healthcare provider to make sure you are taking the right dose for you.

Modifications

People with mild to moderate kidney impairment needn’t adjust their dose. People with severe kidney impairment, measured by a creatinine clearance of 30 or under, should not take valsartan.

How to Take and Store

Valsartan can be taken with or without food. Tablets can be stored safely at room temperature (up to 77 degrees F).

To prepare 160 mL of a 4 mg/mL valsartan suspension, add 80 mL of oral suspending vehicle to an amber glass bottle containing eight losartan 80 mg tablets and shake for at least two minutes. Allow the suspension to stand for a minimum of one hour.

After the standing time, shake the suspension for a minimum of one additional minute. Add 80 mL of oral sweetening vehicle to the bottle and shake the suspension for at least 10 seconds to disperse the ingredients.

The solution can be stored safely at temperatures below 86 degrees F for 30 days and in the refrigerator for up to 75 days.

Side Effects

Although ACE inhibitors are the first-line treatment for hypertension and heart failure, ARBs like valsartan tend to have fewer side effects. Of these, many are mild and tend to resolve as your body adapts to treatment.

Common

These side effects occur in at least 1% of users:

• Headache
• Dizziness
• Dry cough
• Fatigue
• Nasal congestion
• Runny nose
• Sore throat
• Flu-like symptoms
• Nausea
• Diarrhea
• Joint pain
• Back pain

 Let your healthcare provider know if side effects persist or worsen.

Severe

Rare but potentially serious complications include:

• Kidney failure
• Severe hypotension, including orthostatic hypotension (where your blood pressure drops when you stand up)
• Hyperkalemia 

Allergic reactions, including anaphylaxis, are rare but have been known to occur.

If you experience symptoms like shortness of breath, abnormal heart rhythms, changes in vision, hives or fainting, seek out emergency care.

Warnings and Interaction

Valsartan carries a black box warning about fetal toxicity and possible fetal death. Therefore, it should be stopped when pregnancy is detected. Women who are planning to become pregnant should talk to their healthcare provider about other medication options. Valsartan also should be avoided in nursing mothers.

Valsartan causes a major interaction with these drugs:

• Aliskiren
• Cyclosporine
• Diuretics
• Lithium
• Nonsteroidal anti-inflammatory drugs
• Potassium supplements
• Potassium salts
• Rifampin
• Ritonavir

In some cases, you may need to stop taking a drug or adjust your dose per your practitioner’s instructions.

To avoid interactions with valsartan, tell your healthcare provider about any medications you take, including prescription, over-the-counter, nutritional, herbal or recreational drugs.