Valsartan

Boxed warning:

Valsartan can be harmful or fatal to a fetus if taken during pregnancy. If you become pregnant while taking valsartan, stop taking the drug and contact your doctor as soon as possible.

What is valsartan?

Valsartan is an angiotensin II receptor antagonist, a type of drug that relaxes blood vessels by blocking the natural substances that cause them to contract. As a result, it improves blood flow, lowers blood pressure, and helps the heart work more efficiently.¹

What You Need To Know About High Blood Pressure

What is valsartan used to treat?

Valsartan has been approved by the US Food and Drug Administration (FDA) for treating high blood pressure in adults and children. High blood pressure, also called hypertension, can damage the brain, heart, kidneys, and blood vessels over time. The condition increases the risk of serious complications, such as stroke, heart attack, vision loss, and kidney failure, so it's important to treat high blood pressure and try to keep it within the normal range.²

Valsartan can also be used to treat heart failure and to improve a person's chances of survival after a heart attack. Sometimes, doctors prescribe the drug off-label to prevent kidney disease in people with diabetes, but the US FDA has not yet approved this use.³

Dosage forms and strengths

Valsartan is available as a tablet and a liquid suspension. The liquid form is usually prescribed for younger children or others who struggle with swallowing pills. Most adults and older children will take valsartan in tablet form.⁴ ⁵

The tablets are available under the drug’s generic name and under the brand name Diovan in the following strengths: 

• 40mg

• 80mg

• 160mg

• 320mg

The solution is available under the drug’s generic name in one concentration: 4mg/mL.

How do you take valsartan?

You can take valsartan with or without food. However, you should take it around the same time every day, so taking it with a meal may help you remember to take it on time.

If you take the liquid solution, shake the bottle for at least ten seconds before taking a dose to ensure the medication is adequately mixed.

People taking the drug for high blood pressure usually take it once per day, while those taking it for heart disease typically take it twice daily. In most cases, doctors prescribe a low dose of the medication and increase it gradually to determine the lowest effective amount. Follow your doctor's instructions for taking your medication precisely. If anything is unclear, don’t hesitate to ask for clarification.⁶

Seeing results

Most people experience a drop in blood pressure about two hours after taking valsartan, and the drug reaches peak effectiveness around six hours after administration.⁷

It may take up to four weeks to achieve consistent, longer-lasting effects. It’s essential to note that valsartan, like other blood pressure medications, treats high blood pressure but doesn’t cure it. Therefore, continued treatment is necessary to keep blood pressure levels in check. Likewise, valsartan treats but does not cure heart failure.⁸

Who should not take valsartan?

Valsartan is generally safe and effective, but it isn’t suitable for everyone. Contraindications for taking valsartan include the following:⁹

• History of previous allergic reactions to drugs of the same class

• Current therapy with aliskiren (for diabetes) or angiotensin-converting enzyme (ACE) inhibitors, including benazepril

• Pregnancy 

Additionally, people with any of the following conditions should exercise caution when taking valsartan:¹⁰

• Kidney disease or failure

• Renal artery stenosis

• Liver disease

• High potassium levels

• Low sodium levels

• Low blood pressure or dehydration

• Congestive heart failure

• History of a heart attack

Potential side effects of valsartan

People taking valsartan may experience the following side effects, which are typically mild and resolve without intervention:¹¹

• Fatigue

• Headaches

• Dizziness, especially on standing

• Joint pain

• Back pain

• Blurred vision

• Stomach pain

• Nausea

• Diarrhea

• Rash

• Dry cough

If you experience side effects that are persistent or severe, speak with your doctor. Joint pain and back pain are more common among people taking valsartan for heart failure, who may also experience low blood pressure while taking the drug. Abdominal pain, on the other hand, occurs more frequently in those taking the medication for high blood pressure.¹²

The following severe adverse effects may also occur:¹³ ¹⁴

• Trouble breathing

• Swelling in the face or throat

• Trouble swallowing

• Hoarse voice

• Unexplained weight gain

• Severe dermatitis

• Low blood pressure

• Kidney failure

• Hepatitis

• Low platelet or neutrophil count

Any of the following can increase the risk of a drop in blood pressure while taking valsartan, which can lead to fainting or dizziness:

• Diarrhea

• Vomiting

• Sweating

• Fever

• Dehydration

If you experience symptoms of low blood pressure while taking valsartan, sit down, drink some fluids, and contact your doctor before taking your next dose. If your symptoms are severe, call 911 or seek emergency medical attention.

Overdose

If you take too much valsartan, contact your doctor or the National Poison Control helpline. 

Overdose symptoms may include the following:¹⁵

• Fainting

• Dizziness

• Rapid or very slow heart rate

• Low blood pressure

• Reduced level of consciousness

• Shock

If you or someone in your care faints, loses consciousness, or has trouble breathing, call 911 or go to the nearest emergency department immediately.

Allergy information

Rarely, a person may be allergic to valsartan. Symptoms of a drug allergy may include:

• Skin rash

• Itching or swelling of the face, throat, lips, or tongue

• Difficulty breathing

• Dizziness

• Vomiting

• Loss of consciousness

If you experience symptoms of an allergic reaction while taking valsartan, stop taking the drug and seek emergency medical care.

Long-term use of valsartan

Many people need to take valsartan for several years or longer.

Research has demonstrated that valsartan continues to be safe and effective when used long-term. Valsartan has been shown to be well-tolerated for longer periods in children being treated for high blood pressure with or without kidney disease.¹⁶ ¹⁷

Pregnancy category

The US FDA designated valsartan a pregnancy category D drug, which means there’s evidence of harm to the fetus if the drug is taken during pregnancy.¹⁸

Valsartan and pregnancy

Taking valsartan or any other angiotensin II receptor antagonist while pregnant, particularly in the second and third trimesters, can have serious adverse effects on the unborn child.

Possible complications include:

• Impaired kidney function and kidney failure

• Underdevelopment of the lungs

• Skeletal malformations

• Low blood pressure

• Death

Stop taking valsartan and contact your doctor immediately if you learn you’re pregnant while taking the medication.¹⁹

Valsartan and breastfeeding

There is no adequate data on the presence of valsartan in human breast milk or its effects on infants. However, risk cannot be ruled out. Therefore, your doctor will weigh the risks and benefits to decide if you should breastfeed while taking the medication. Your doctor may suggest formula feeding or switching to a different blood pressure or heart medication.²⁰

Missed doses

If you forget a dose of valsartan, take it as soon as you remember unless it's nearly time for the next one. Do not take extra valsartan to make up for the missed dose.

Drug interactions

Combining valsartan with certain other drugs can increase the risk of complications. Valsartan may interact with prescription and over-the-counter medications, including the following:²¹ ²²

• Aliskiren in patients with diabetes

• Other blood pressure medications

• ACE inhibitors like benazepril (Lotensin), captopril (Capoten), and enalapril (Vasotec)

• Monoamine oxidase inhibitors (MAOIs), such as isocarboxazid (Marplan)

• Aspirin and other non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen (Advil, Motrin), diflunisal (Dolobid), and naproxen (Naprosyn, Aleve) and including selective COX-2 inhibitors, such as celecoxib (Celebrex) and meloxicam (Mobic)

• Diuretics, particularly the potassium-sparing medications like spironolactone (Aldactone) and amiloride (Midamor), and other angiotensin II receptor antagonists, such as losartan (Cozaar)

• Potassium supplements and salt substitutes containing potassium

• Medications that increase potassium levels, such as beta-blockers, calcium channel blockers, and others²³

• Antibiotics, including amikacin (Amikin), rifampin, and trimethoprim

• Antiviral medications, such as ritonavir (Norvir) and acyclovir (Zovirax)

• Immune modulators like cyclosporine (Neoral, Sandimmune) and voclosporin (Lupkynis)

• Medications for prostate enlargement, such as alfuzosin (Uroxatral)

• Lithium

This is not a complete list of all drugs that may interact with valsartan. Inform your doctor of all medications, herbs, and supplements you take regularly or occasionally.

Can I drink alcohol while taking valsartan?

There are several factors to consider in determining the safety of combining alcohol with valsartan, such as the severity of the condition valsartan is treating, as well as any other medications you take or medical conditions you have. Ask your doctor if it’s safe to drink alcohol while taking valsartan, even if you don’t drink often.

What to discuss with your doctor before starting valsartan

Valsartan is dangerous if taken during pregnancy. Tell your doctor if you are pregnant, breastfeeding, or planning to become pregnant.

Additionally, tell your doctor if you have a history of:²⁴

• Heart disease

• Kidney disease 

• Liver disease

• Bile duct blockages

• High potassium levels

• Allergic reaction to ACE inhibitors

Be sure to bring a complete list of all medications and supplements you take, including prescription and over-the-counter drugs and those you only take occasionally.

Stopping valsartan

It's essential to continue taking valsartan even if you feel better or your blood pressure readings improve. Unless you become pregnant, experience severe side effects, or notice signs of an allergic reaction, do not stop taking the drug without first speaking with your doctor.

Drug approval history

• 1996: Valsartan earned US FDA approval²⁵

• 2018: Certain valsartan products were recalled due to contamination²⁶

Tips for taking valsartan

• Take valsartan at the same time each day, either alone or with food.

• You can store the suspension form of valsartan at room temperature for up to 30 days or refrigerate it for up to 75 days.

• Valsartan can cause dizziness and fainting when you get up too quickly, especially when starting treatment or increasing the dose. Stand up slowly to reduce the risk of falls. When transitioning from lying down or sitting to standing, place your feet on the floor for a few minutes before standing up.

• Dehydration can cause a drop in blood pressure, which may be more severe in people taking medications that lower blood pressure, including valsartan. Dehydration may be triggered by sweating, fever, vomiting, or diarrhea. Stay hydrated to reduce the risk.

• Follow your doctor's recommendations for diet and exercise to help improve your blood pressure.

Frequently asked questions

Why was valsartan taken off the market?

In 2018, some generic valsartan lots were recalled by the US FDA (and by global health authorities) because they contained concerning, unexpected impurities, most notably, a potentially cancer-causing toxin, N-nitrosodiethylamine (NDMA).²⁷

Note that not all batches of valsartan were contaminated or recalled.

What is the best time to take valsartan?

You can take valsartan at any time of the day, but it's best to take it at the same time every day because the drug has a half-life of six hours and will be out of your system in 24 hours.²⁸ ²⁹