Formulary
Valsartan: Indications, Dosing, Side Effects and Interactions
Valsartan clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Valsartan: Indications, Dosing, Side Effects and Interactions
Valsartan clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Hypertension**
- **Adult** (By Mouth): Initially 80 mg once daily, increased if necessary up to 320 mg daily, doses to be increased at intervals of 4 weeks.
**Hypertension with intravascular volume depletion**
- **Adult** (By Mouth): Initially 40 mg once daily, increased if necessary up to 320 mg daily, doses to be increased at intervals of 4 weeks.
**Heart failure when ACE inhibitors cannot be used, or in conjunction with an ACE inhibitor when a beta-blocker cannot be used,Heart failure, in conjunction with an ACE inhibitor when a beta-blocker cannot be used (under expert supervision)**
- **Adult** (By Mouth): Initially 40 mg twice daily, increased to up to 160 mg twice daily, doses to be increased at intervals of at least 2 weeks.
**Myocardial infarction with left ventricular failure or left ventricular systolic dysfunction (adjunct)**
- **Adult** (By Mouth): Initially 20 mg twice daily, increased if necessary up to 160 mg twice daily, doses to be increased over several weeks if tolerated.
**Hypertension for valsartan**
- **Child 6-17 years (under expert supervision) (body-weight 18-34 kg)** (By mouth): Initially 40 mg once daily, adjusted according to response; maximum 80 mg per day.
- **Child 6-17 years (under expert supervision) (body-weight 35-79 kg)** (By mouth): Initially 80 mg once daily, adjusted according to response; maximum 160 mg per day.
- **Child 6-17 years (under expert supervision) (body-weight 80 kg and above)** (By mouth): Initially 80 mg once daily, adjusted according to response; maximum 320 mg per day.
Cautions
II receptor antagonists Aortic or mitral valve stenosis; elderly (lower initial doses may be appropriate); hypertrophic cardiomyopathy; patients of black African or African-Caribbean origin; patients with a history of angioedema; patients with primary aldosteronism (may not benefit from an angiotensin-II receptor antagonist); renal artery stenosis Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: with hyperkalaemia with persistent postural hypotension i.e. recurrent drop in systolic blood pressure 20 mmHg (risk of syncope and falls)
Contraindications
II receptor antagonists The combination of an angiotensin-II receptor antagonist with aliskiren is contra-indicated in patients with an eGFR less than 60 mL/minute/1.73 m 2 ; the combination of an angiotensin-II receptor antagonist with aliskiren is contra-indicated in patients with diabetes mellitus Contra-indications For valsartan Biliary cirrhosis; cholestasis
Side effects
II receptor antagonists Common or very common Abdominal pain; asthenia; back pain; cough; diarrhoea; dizziness; headache; hyperkalaemia; hypotension; nausea; postural hypotension (more common in patients with intravascular volume depletion, e.g. those taking high-dose diuretics); renal impairment; vertigo; vomiting Uncommon Angioedema; myalgia; skin reactions; thrombocytopenia Rare or very rare Arthralgia; hepatic function abnormal Side-effects For valsartan Uncommon Syncope Frequency not known Hyponatraemia; neutropenia; respiratory disorders; serum sickness; vasculitis
Interactions
**Other interactions (9):**
- Clinical trial data has shown that dual blockade of the renin-angiotensin-aldosterone-system (RAAS) through the combined use of ACE-inhibitors, angiotensin II receptor blockers or aliskiren is...
- Concomitant use not recommended Lithium Reversible increases in serum lithium concentrations and toxicity have been reported during concomitant administration of lithium with angiotensin converting...
- If the combination proves necessary, careful monitoring of serum lithium levels is recommended.
- If a diuretic is also used, the risk of lithium toxicity may presumably be increased further.
- Potassium-sparing diuretics, potassium supplements, salt substitutes containing potassium and other substances that may increase potassium levels If a medicinal product that affects potassium levels...
- Transporters In vitro data indicates that valsartan is a substrate of the hepatic uptake transporter OATP1B1/OATP1B3 and the hepatic efflux transporter MRP2.
Pregnancy
Important safety information For all angiotensin II receptor antagonists MHRA/CHM advice: ACE inhibitors and angiotensin II receptor antagonists: not for use in pregnancy (December 2014) See Conception and contraception and Pregnancy . MHRA/CHM advice: ACE inhibitors and angiotensin II receptor antagonists: recommendations on how to use for breastfeeding (December 2014) See Breast feeding .
Breast feeding
II receptor antagonists Information on the use of angiotensin-II receptor antagonists in breast-feeding is limited. They are not recommended in breast-feeding. Alternative treatment options, with better established safety profile during breast-feeding, are preferable M (recommendation also supported by specialist sources).
Hepatic impairment
II receptor antagonists In general, manufacturers advise caution in mild to moderate impairment (limited information available); avoid in severe impairment (no information available). Hepatic impairment For valsartan Dose adjustments Manufacturer advises maximum 80 mg daily in mild to moderate impairment.
Renal impairment
II receptor antagonists Dose adjustments In general, manufacturers advise start with low dose and adjust according to response. Renal impairment For valsartan See Prescribing in renal impairment . Caution if creatinine clearance less than 10 mL/minute (no information available). M
Medicinal forms
Solution,Tablet,Capsule,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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