Valsartan

About Valsartan

Valsartan blocks the receptor for angiotensin II, a hormone that tightens blood vessels, so vessels relax and blood pressure falls. The Diovan label covers high blood pressure in adults and children 1 year and older; heart failure in adults (NYHA class II to IV), where it reduces hospital admissions, although there is no evidence of added benefit when it is taken with an adequate dose of an ACE inhibitor; and clinically stable adults whose heart is weakened after a heart attack, where it reduces cardiovascular death. For blood pressure, adults start at 80 or 160 mg once a day, up to 320 mg, and children at 1 mg per kg once a day, up to 40 mg. Heart failure starts at 40 mg twice a day, raised toward 160 mg twice a day; after a heart attack it can start as early as 12 hours later at 20 mg twice a day, with a target of 160 mg twice a day.

The boxed warning is fetal toxicity: drugs acting on the renin-angiotensin system can injure and kill a developing baby, so valsartan is stopped as soon as pregnancy is detected. It must not be taken by anyone allergic to it or with aliskiren in diabetes. Blood pressure can drop too far in people low in salt or fluid; kidney function can worsen in people whose kidneys depend on this hormone system, so it is checked; and potassium can rise, as seen in some people with heart failure. Angioedema has been reported, sometimes in people who had it with an ACE inhibitor, and valsartan is not given again after it. Headache, dizziness, viral infections, tiredness and stomach pain were the most common side effects in high blood pressure; dizziness, low blood pressure and diarrhea were among them in heart failure.

For children aged 1 to 5, or children who cannot swallow tablets, a pharmacy can make a 4 mg per mL suspension from Diovan tablets; it gives higher blood levels than the same dose of tablets, so the two are not swapped milligram for milligram. A separate oral solution of the same strength (Prexxartan and generics) is labeled for high blood pressure from age 6, and for heart failure or after a heart attack only in people who cannot swallow tablets; it is taken twice a day, and its label says it is not therapeutically equivalent to Diovan tablets. Breastfeeding is not recommended. Several valsartan products were recalled from July 2018 for nitrosamine impurities, and the FDA advised patients to keep taking their medicine until the pharmacist could replace it. Valsartan with hydrochlorothiazide (Diovan HCT and generics) is a separate prescription for high blood pressure, used when one drug is not enough or first when several are likely to be needed; its use in children is not established. The hydrochlorothiazide adds warnings: it is not for people who make no urine or are allergic to sulfonamide-derived drugs; it can lower potassium, sodium and magnesium and affect blood sugar, cholesterol, uric acid (gout) and calcium; sudden decreased vision or eye pain can signal a glaucoma that, untreated, can cause permanent vision loss; it can worsen lupus; and it is linked to non-melanoma skin cancer, so sun protection and skin checks are advised.

Taking Valsartan

How to take it

Tablets once a day for high blood pressure and twice a day for heart failure or after a heart attack, with or without food, at the same times each day; the oral solution is taken twice a day. Shake a pharmacy-made suspension well, for at least 10 seconds, before each dose.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

Tablets and the oral solution at room temperature, tablets protected from moisture in a tightly closed container; a pharmacy-made suspension at room temperature for up to 30 days or in the refrigerator for up to 75 days. Keep all out of reach of children.

Interactions to know about

Potassium supplements, potassium salt substitutes, potassium-sparing diuretics and other drugs that raise potassium, such as heparin, add to the risk of high potassium, and it raises lithium levels. NSAIDs such as ibuprofen and naproxen can blunt its effect and strain the kidneys. It is not taken with aliskiren in diabetes, other drugs that block this system are generally avoided, and Entresto already contains valsartan, so its label says to avoid taking it with an ARB.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Valsartan differs from pharmacy to pharmacy

Generic valsartan tablets have many makers and cost pharmacies little, so much of a quote is the dispensing fee and markup, which differ between pharmacies. A prescription that names Diovan or Diovan HCT and blocks substitution is priced as a brand.

The oral solution has only a few makers and cannot be swapped for tablets at the counter, and a suspension made from tablets keeps 30 days at room temperature or 75 in the refrigerator, so it is filled more often than tablets.

Ways to pay less for Valsartan without insurance

• Ask for generic valsartan, tablets or oral solution, and make sure the prescription does not block substitution.
• Ask whether valsartan is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• If you take 320 mg once a day, ask the prescriber to write it as one 320 mg tablet rather than two 160 mg tablets.
• Once your dose is stable, ask for a ninety-day supply.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Valsartan

1. 1.Is my prescription for tablets or a liquid, and can they be swapped?
2. 2.When will my potassium and kidney function be checked?
3. 3.Should I avoid potassium supplements, salt substitutes or ibuprofen with it?
4. 4.What should I do if I become pregnant or plan to?

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