valsartan: clinical use

Prescribing considerations

• Confirm that the indication, patient age and formulation are covered by the selected product licence.
• Assess volume depletion and hypotension risk before initiation, particularly with diuretics or acute fluid loss.
• Avoid routine dual renin–angiotensin system blockade.
• Review pregnancy intentions and arrange an established alternative when appropriate.
• Consider specialist input for severe or unstable heart failure, renovascular disease, significant renal impairment, hypovolaemia, hypotension or haemodynamically significant valve disease.

Contraindications and cautions

• Hypersensitivity to valsartan or product excipients.
• Severe hepatic impairment, biliary cirrhosis or cholestasis.
• Second or third trimester of pregnancy.
• Concomitant aliskiren in diabetes mellitus or renal impairment with GFR below the product-defined threshold.

Monitoring

• Check blood pressure, renal function, potassium and sodium before treatment.
• Reassess blood pressure, renal function and electrolytes after initiation or a treatment change, with earlier or more frequent checks in higher-risk patients.
• Repeat assessment during acute illness, dehydration or possible renal deterioration.
• Investigate clinically important rises in creatinine or potassium and review contributory medicines such as NSAIDs and potassium-raising agents.

Clinical pharmacology

Valsartan selectively blocks angiotensin II AT1 receptors. It is highly protein-bound, undergoes limited metabolism and is eliminated mainly unchanged through biliary excretion, with a smaller renal contribution.

Formulation and product differences

• Selected products include hard capsules, film-coated tablets and an oral solution.
• The oral solution is licensed for paediatric hypertension and is suitable when tablets cannot be swallowed.
• Systemic exposure is higher with the oral solution than with tablets, so switching requires blood-pressure monitoring and product-specific adjustment.
• The oral solution contains sucrose, methyl parahydroxybenzoate, propylene glycol and sodium; these excipients may matter for individual patients.
• Some tablet presentations are scored, but divisibility must be checked against the specific product SmPC.

Capsule

Route: Oral

Strengths: 40 mg, 80 mg, 160 mg

Oral solution

Route: Oral

Strengths: 3 mg/mL

Tablet

Route: Oral