valsartan

(val sar' tan)

Diovan

Pregnancy Category C (first trimester)

Pregnancy Category D (second and third trimesters)

Drug classes
Angiotensin II receptor blocker (ARB)
Antihypertensive

Therapeutic actions
Selectively blocks the binding of angiotensin II to specific tissue receptors found in the
vascular smooth muscle and adrenal gland; this action blocks the vasoconstricting effect
of the renin–angiotensin system as well as the release of aldosterone, leading to decreased
BP; may prevent the vessel remodeling associated with the development of
atherosclerosis.

Indications
• Treatment of hypertension, alone or in combination with other antihypertensives
• Treatment of heart failure in patients who are intolerant of angiotensin-converting
enzyme (ACE) inhibitors

Contraindications and cautions

• Contraindicated with hypersensitivity to valsartan, pregnancy (use during second
or third trimester can cause injury or even death to fetus), lactation.
• Use cautiously with hepatic or renal dysfunction, hypovolemia.

Available forms
Tablets—40, 80, 160, 320 mg

Dosages
ADULTS
80 mg PO daily; range 80–320 mg/day.
• Heart failure: Starting dose is 40 mg bid, titration to 80 mg and 160 mg bid
should be done to the highest dose, as tolerated by the patient. Maximum daily
dose is 320 mg daily. Concomitant use with an ACE inhibitor and a beta blocker
is not recommended.
PEDIATRIC PATIENTS
Safety and efficacy not established.
PATIENTS WITH HEPATIC OR RENAL IMPAIRMENT
Exercise caution and monitor patient frequently.

Pharmacokinetics
Route Onset Peak
Oral Varies 2–4 hr
Metabolism: Hepatic; T1/2: 6 hr
Distribution: Crosses placenta; passes into breast milk
Excretion: Feces and urine

Adverse effects
• CNS: Headache, dizziness, syncope, muscle weakness
• CV: Hypotension
• Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin
• GI: Diarrhea, abdominal pain, nausea, constipation, dry mouth, dental pain
• Respiratory: URI symptoms, cough, sinus disorders
• Other: Cancer in preclinical studies, back pain, fever, gout

Nursing considerations
Assessment
• History: Hypersensitivity to valsartan; pregnancy, lactation; hepatic or renal
dysfunction; hypovolemia
• Physical: Skin lesions, turgor; T; reflexes, affect; BP; R, respiratory auscultation;
liver and renal function tests

Interventions
• Administer without regard to meals.
• Ensure that patient is not pregnant before beginning therapy; suggest using barrier
birth control while using drug; fetal injury and deaths have been reported.
• Find alternative method of feeding infant if drug is being given to nursing mother.
Depression of renin–angiotensin system in infants is potentially very dangerous.
• Alert surgeon and mark patient's chart that valsartan is being given. Blockage of
renin–angiotensin system following surgery can produce problems. Hypotension
may be reversed with volume expansion.
• Monitor patient closely in any situation that may lead to decrease in BP secondary
to reduction in fluid volume—excessive perspiration, dehydration, vomiting,
diarrhea—as excessive hypotension can occur.

Teaching points
• Take this drug without regard to meals. Do not stop taking drug without
consulting your nurse or physican.
• Use a barrier method of birth control while using this drug; if you become
pregnant or desire to become pregnant, consult your physician.
• These side effects may occur: Dizziness (avoid driving or performing hazardous
tasks); headache (medications may be available to help); nausea, vomiting,
diarrhea (proper nutrition is important; consult your dietitian); symptoms of upper
respiratory tract infection, cough (do not self-medicate; consult your nurse or
physician if this becomes uncomfortable).
• Report fever, chills, dizziness, pregnancy.

Adverse effects in Italic are most common; those in Bold are life-threatening.