Angiotensin receptor blockers · Cardiovascular
Valsartan
Diovan®(brand names vary by market)
The ARB that carries the heart-failure and post-infarct evidence.
Also: capsule
Mechanism
Blocks the angiotensin II type 1 receptor directly, leaving bradykinin metabolism untouched, which is why the cough does not happen.
Open the interactive pathwayIndications
- Hypertension
- Heart failure with reduced ejection fraction
- Post myocardial infarction with left ventricular dysfunction
Formulations
Dosing concepts
Substitution
The usual reason to reach for it is an ACE-inhibitor cough. Angioedema is a different matter: cross-reactivity is low but not zero, and the decision belongs with a specialist.
Heart failure
Target doses in HFrEF are considerably higher than antihypertensive doses, which is a frequent under-treatment trap.
Concepts, not prescribing instructions. Practice numbers live in current references and local protocols.
Pharmacokinetics
- Bioavailability
- ~25%
- Half-life
- ~6 h, with receptor binding outlasting the plasma level
- Elimination
- hepatic: Mostly biliary; only a small renal fraction
- Protein binding
- ~95%
Adverse effects
- Hyperkalemiacommon & serious
- Hypotension and dizzinesscommon
- Acute kidney injury in the volume-depleteserious
- AngioedemaseriousMuch rarer than with ACE inhibitors, but described.
Contraindications & precautions
Contraindications
- Pregnancy
- Bilateral renal artery stenosis
- Concurrent aliskiren in diabetes
Precautions
- Volume depletion
- Renal impairment
- Combination with an ACE inhibitor, which is now avoided
Interactions
- ACE inhibitors / ARBs + Potassium-sparing diuretics, K supplements, salt substitutescautionAdditive hyperkalemia, worst with renal impairment layered on top.
- ACE inhibitor / ARB + diuretic + NSAID (the 'triple whammy')avoidAcute kidney injury, classically in a dehydrated older adult who bought ibuprofen for a sore knee.
- ACE inhibitors / ARBs / thiazides + LithiumcautionLithium toxicity: tremor, confusion, ataxia, renal injury.
Monitoring
Potassium and creatinine
Same class effects as an ACE inhibitor, cough aside · 1 to 2 weeks after any change
Blood pressure
Effect
Counselling points
- Once or twice daily as prescribed.
- This is the alternative for people who developed a cough on the other type; it should not do the same.
- Avoid potassium salt substitutes.
- Stop and tell us if you become pregnant.
Clinical pearls
- ARBs are not gentler than ACE inhibitors on the kidney or on potassium. The only reliable difference is the cough.
- Combining an ACE inhibitor with an ARB doubles the adverse events without improving outcomes; that combination was abandoned on evidence, not on theory.
References & review
- Valsartan product monograph (consult the current version for your market) (monograph)
- Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)
Last reviewed 2026-08-16 · jurisdiction: global · drug information changes; verify against current references before practice use.