Angiotensin II receptor blockers (ARBs)
ATC code: C09CA03 (Valsartan)
Selective AT1 angiotensin II receptor antagonist. Blocks vasoconstriction, aldosterone secretion, and proliferative effects of angiotensin II. Does not cause dry cough, unlike ACE inhibitors, because it does not affect bradykinin degradation. Half-life is about 6 hours, but the clinical effect lasts 24 hours.
First line
Valsartan is a proven ACE inhibitor alternative in HFrEF. The Val-HeFT trial showed a 27% reduction in hospitalizations when valsartan was added to background therapy. Sacubitril/valsartan (Entresto) is a separate drug that outperformed enalapril in PARADIGM-HF and is now preferred in HFrEF.
Prescribed when ACE inhibitors are not tolerated. Per 2021, sacubitril/valsartan (Entresto) is preferred over valsartan monotherapy in HFrEF.
First line
First-line antihypertensive. Starting dose 80 mg once daily, maximum 320 mg. Prescribed as an ACE inhibitor alternative or when ACEi is not tolerated (cough). Frequently included in fixed-dose combinations with amlodipine and/or hydrochlorothiazide. Antihypertensive effect develops over 2-4 weeks.
First line
Valsartan is an alternative to captopril in post-MI heart failure. The VALIANT trial (over 14,000 patients) showed that valsartan 160 mg twice daily was non-inferior to captopril for mortality and cardiovascular events. Prescribed for patients who do not tolerate ACE inhibitors.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Valsartan is an angiotensin II receptor blocker. It is prescribed for hypertension, heart failure, and after myocardial infarction ( 2023, SEH-LELHA, 2017). In anti-aging regimens, valsartan is given to healthy normotensives for general vessel protection. In people with normal blood pressure, no clinical studies of prophylactic use exist. The drug can cause dizziness, hyperkalemia, angioedema in predisposed people, and teratogenicity. If valsartan was prescribed to a healthy person, consider seeking a second opinion.
6 pairs found. Sorted from critical to minor.
Mechanism
Dual RAAS blockade (ACE-I + ARB). Additive hyperkalaemia, hypotension, and acute kidney injury risk without added benefit.
Symptoms
Weakness, postural dizziness, syncope. Reduced urine output, rising creatinine. Weakness and paraesthesia from hyperkalaemia.
Management
The combination is not prescribed. Choose one: ACE-I if tolerated, ARB if there is a dry cough or intolerance.
Sources
Mechanism
Trimethoprim blocks collecting duct sodium channels (amiloride-like mechanism) and reduces potassium secretion. Valsartan (ARB) additionally retains potassium through aldosterone suppression.
Symptoms
Muscle weakness, paraesthesia in the limbs, slowed pulse, arrhythmias. ECG shows peaked T waves and widened QRS. Severe cases progress to cardiac arrest. Symptoms typically appear within 1–2 weeks of starting the combination.
Management
During co-trimoxazole therapy, check potassium 3–5 days after start. In older patients and chronic kidney disease, prefer alternative antibiotics: nitrofurantoin or fosfomycin.
Mechanism
Dual RAAS blockade (ACE-I + ARB). Proven in ONTARGET and VA NEPHRON-D trials: increased hyperkalaemia, hypotension, and acute kidney injury without cardioprotection.
Symptoms
Muscle weakness, paraesthesia, slowed pulse, arrhythmias. ECG: peaked T waves, widened QRS. Severe cases progress to cardiac arrest.
Management
The combination is not prescribed. Choose one: ACE-I (enalapril) if tolerated, ARB (valsartan) if there is a dry cough or intolerance.
Sources
Mechanism
Valsartan (ARB) suppresses the RAAS, while spironolactone blocks aldosterone receptors. Dual aldosterone blockade raises hyperkalaemia risk.
Symptoms
Muscle weakness, paraesthesia in the limbs, slowed pulse, arrhythmias. ECG shows peaked T waves and widened QRS. Severe cases progress to cardiac arrest. Symptoms typically appear within 1–2 weeks of starting the combination.
Management
The combination is appropriate in heart failure with reduced ejection fraction. Check potassium and creatinine 1 week after start, then monthly. If potassium exceeds 5.5 mmol/L, reduce the spironolactone dose.
Sources
Mechanism
Analgesic aspirin doses weaken the ARB's antihypertensive effect via vasodilator prostaglandin suppression. Cardioprotective doses are clinically minor.
Symptoms
Gradual blood pressure rise at high aspirin doses. At cardioprotective doses, no significant changes.
Management
Cardioprotective aspirin doses (75–100 mg) are acceptable without adjustment. At high doses, monitor blood pressure and increase valsartan if needed. Alternative analgesic: paracetamol.
Mechanism
Standard combination in heart failure with reduced ejection fraction. Additive antihypertensive effect and complementary neurohormonal blockade.
Symptoms
On starting, in older or hypovolaemic patients: symptomatic hypotension, dizziness. Bisoprolol bradycardia is amplified.
Management
Start both at minimal doses with up-titration every 2 weeks to target. Check standing/sitting BP, heart rate, creatinine and potassium at 2 weeks. In heart failure, target maximum tolerated doses (bisoprolol up to 10 mg, valsartan up to 320 mg). Outcome evidence base is extensive.
Sources
Opens the checker prefilled with this drug. Pick the second one from your regimen.
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FDA category D. Drugs acting on the renin-angiotensin system cause fetal renal injury, oligohydramnios, pulmonary and skeletal hypoplasia. Discontinue when pregnancy is planned.
No data on valsartan excretion in breast milk. Not recommended during breastfeeding. Alternative antihypertensives are chosen if therapy is needed.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Valsartan is evaluated for the following indications with varying evidence strength: Post-myocardial infarction heart failure (evidence tier A), Hypertension (evidence tier A), Heart failure (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Valsartan (≥ 1 in 100): Dizziness, Hyperkalemia, Hypotension (more common with hypovolemia and in heart failure), Creatinine elevation, Headache. See the Safety section for uncommon and serious reactions.
FDA category D. FDA category D. Drugs acting on the renin-angiotensin system cause fetal renal injury, oligohydramnios, pulmonary and skeletal hypoplasia. Discontinue when pregnancy is planned.
No data on valsartan excretion in breast milk. Not recommended during breastfeeding. Alternative antihypertensives are chosen if therapy is needed.
Valsartan is contraindicated in: Pregnancy (all trimesters) – FDA category D; Severe hyperkalemia; Bilateral renal artery stenosis or stenosis of a single functioning kidney; Concurrent aliskiren in patients with diabetes or CKD; Severe hepatic impairment, biliary cirrhosis, cholestasis. Full list in the Safety section.