BLACK BOX WARNING
- fetal toxicity
valsartan
Brand: Diovan
⚠ BBW Prototype: losartan
Drug Class: angiotensin II receptor blocker (ARB)
Drug Family: antihypertensive
Subclass: AT1 receptor antagonist
Organ Systems: cardiovascularrenal
Mechanism of Action
Selective AT1 receptor blocker; reduces vasoconstriction and aldosterone without ACE inhibitor cough.
AT1 receptor
Indications
- hypertension
- heart failure (post-MI)
- post-MI LV dysfunction
Contraindications
- pregnancy
- concomitant aliskiren in DM or CKD
Adverse Effects
Common
- dizziness
- hyperkalemia
- hypotension
Serious
- AKI
- teratogenicity
Pharmacokinetics (ADME)
| Absorption | 23-39% bioavailability; food reduces AUC 40% |
| Distribution | high protein binding |
| Metabolism | minimal hepatic (not CYP) |
| Excretion | fecal 83%, renal 13% |
| Half-life | 6-9 hours |
| Onset | 2 hours |
| Peak | 4-6 hours |
| Duration | 24 hours |
| Protein Binding | 95% |
| Vd | 17 L |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| potassium-sparing diuretics | additive hyperkalemia | major |
| NSAIDs | reduced antihypertensive effect; AKI | moderate |
Nursing Considerations
- May be taken with or without food but consistent timing preferred
- Monitor K+, BP, renal function
- Component of sacubitril/valsartan (Entresto)
Clinical Pearls
- VAL-HeFT trial: reduced HF hospitalizations
- Combined with sacubitril as Entresto — first-line HFrEF therapy
Safety Profile
Pregnancy contraindicated
Lactation avoid
Renal Adjustment Not required
Hepatic Adjustment Required
TDM Not required
Guideline Update pending
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.