Valsartan

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Valsartan
Valsartan skeletal.svg
Valsartan ball-and-stick.png
Clinical data
Trade namesDiovan
AHFS/Drugs.comMonograph
MedlinePlusa697015
License data
Pregnancy
category
  • US: D (Evidence of risk)
    Routes of
    administration    		oral
    ATC code
    Legal status
    Legal status
    Pharmacokinetic data
    Bioavailability25%
    Protein binding95%
    Elimination half-life6 hours
    ExcretionRenal 30%, biliary 70%
    Identifiers
    CAS Number
    PubChem CID
    IUPHAR/BPS
    DrugBank
    ChemSpider
    UNII
    KEGG
    ChEBI
    ChEMBL
    ECHA InfoCard100.113.097 Edit this at Wikidata
    Chemical and physical data
    FormulaC24H29N5O3
    Molar mass435.519 g/mol
    3D model (JSmol)
      (verify)
    Valsartan (trade name Diovan) is mainly used for treatment of high blood pressure, congestive heart failure, and to increase the chances of living longer after a heart attack. It is an angiotensin II receptor antagonist (commonly called an ARB, or angiotensin receptor blocker), that is selective for the type I (AT1) angiotensin receptor.

    Medical uses[edit]

    Valsartan is used to treat high blood pressure, congestive heart failure, and to reduce death for people with left ventricular dysfunction after having had a heart attack.[1][2]
    There is contradictory evidence with regard to treating people with heart failure with a combination of an angiotensin receptor blocker like valsartan and an angiotensin-converting enzyme inhibitor, with two major clinical trials (CHARM-additive and ValHeFt) showing a reduction in death, and two others (VALIANT and ONTARGET) showing no benefits, and more adverse effects including heart attacks.[1]
    In people with type II diabetes and high blood pressure or albumin in the urine, valsartan is used to slow the worsening and the development end-stage renal disease.[3]

    Contraindications[edit]

    The packaging for valsartan includes a warning stating the drug should not be used with the renin inhibitor aliskiren in people with diabetes mellitus. It also states the drug should not be used in people with kidney disease.[2]
    Valsartan falls in FDA pregnancy category D and includes a black box warning for fetal toxicity.[2] Discontinuation of these agents is recommended immediately after detection of pregnancy and an alternative medication should be started.[2] The US labeling makes no recommendation regarding continuation or discontinuation of valsartan for breast-feeding mothers.[2] The Canadian labeling does not recommend use by nursing women.[4]

    Side effects[edit]

    Rates of side effects depends on the reason the medication is used.

    Heart failure[edit]

    Rates of adverse effects are based on a comparison versus placebo in people with heart failure.[5] Most common side effects include dizziness (17% vs 9% ), low blood pressure (7% vs 2%), and diarrhea (5% vs 4%).[5] Less common side effects include joint pain, fatigue, and back pain (all 3% vs 2%).[5]

    Hypertension[edit]

    Clinical trials for valsartan treatment for hypertension versus placebo demonstrate side effects like viral infection (3% vs 2%), fatigue (2% vs 1%) and abdominal pain (2% vs 1%). Minor side effects that occurred at >1% but were similar to rates from the placebo group include:[5]

    Interactions[edit]

    Co-Diovan (Valsartan and hydrochlorothiazide)
    The US prescribing information lists the following drug interactions for valsartan:
    • Other inhibitors of the renin-angiotensin system may increase the risks of low blood pressure, kidney problems, and hyperkalemia
    • Potassium sparing diuretics, potassium supplements, salt substitutes containing potassium may increase the risk of hyperkalemia.
    • NSAIDs may increase the risk of kidney problems and may interfere with blood pressure-lowering effects.
    • Valsartan may increase the concentration of lithium.[2]

    Mechanism of action[edit]

    Valsartan blocks the actions of angiotensin II, which include constricting blood vessels and activating aldosterone, to reduce blood pressure.[6] The drug binds to angiotensin type I receptors (AT1), working as an antagonist. This mechanism of action is different than that of the ACE inhibitor drugs, which block the conversion of angiotensin I to angiotensin II. As valsartan acts at the receptor, it can provide more complete angiotensin II antagonism since angiotensin II is generated by other enzymes as well as ACE. Also, valsartan does not affect the metabolism of bradykinin like ACE inhibitors do.[6]

    Economics[edit]

    In 2010, valsartan (trade name Diovan) achieved annual sales of $2.052 billion in the United States and $6.053 billion worldwide.[7] The patents for valsartan and valsartan/hydrochlorothiazide expired in September 2012.[8][9]

    Research[edit]

    In people with impaired glucose tolerance, valsartan may decrease the incidence of developing diabetes mellitus type 2. However, the absolute risk reduction is small (less than 1 percent per year) and diet, exercise or other drugs, may be more protective. In the same study, no reduction in the rate of cardiovascular events (including death) was shown.[10]
    In one study of people without diabetes, valsartan reduced the risk of developing diabetes mellitus over amlodipine, mainly for those with hypertension.[11]
    A prospective study demonstrated a reduction in the incidence and progression of Alzheimer's disease and dementia.[12]

    Combination drugs[edit]

    Amlodipine and valsartan are combination drugs for hypertension. The combination is not approved for use by anyone younger than 18 years old. For who have diabetesor kidney disease the combination drugs cannot be given with medication that contains aliskiren.[13]

    See also[edit]

    References[edit]

    1. ^ Jump up to:a b Randa, Hilal-Dandan (2011). "Chapter 26. Renin and Angiotensin". In Brunton, L. L.; Chabner, Bruce; Knollmann, Björn C. Goodman & Gilman's The Pharmacological Basis of Therapeutics (12th ed.). New York: McGraw-Hill. ISBN 978-0-07-162442-8.
    2. ^ Jump up to:a b c d e f "Diovan prescribing information" (PDF). Novartis.
    3. Jump up^ Inzucchi, Silvio E.; Bergenstal, Richard M.; Buse, John B.; Diamant, Michaela; Ferrannini, Ele; Nauck, Michael; Peters, Anne L.; Tsapas, Apostolos; Wender, Richard (2015-01-01). "Management of Hyperglycemia in Type 2 Diabetes, 2015: A Patient-Centered Approach: Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes". Diabetes Care. 38 (1): 140–149. doi:10.2337/dc14-2441. ISSN 0149-5992. PMID 25538310.
    4. Jump up^ "DIOVAN Product Monograph". Health Canada Drug Product Database. Novartis Pharmaceuticals Canada Inc. Retrieved 5 November 2015.
    5. ^ Jump up to:a b c d "DailyMed - VALSARTAN - valsartan tablet". dailymed.nlm.nih.gov. Retrieved 2015-11-04.
    6. ^ Jump up to:a b Katzung, Bertram G; Trevor, Anthony J. (2015). "Chapter 11". Basic & Clinical Pharmacology (13 ed.). McGraw-Hill Education. ISBN 978-0071825054.
    7. Jump up^ "Novartis Annual Report 2010" (PDF).
    8. Jump up^ Philip Moeller (April 29, 2011). "Blockbuster Drugs That Will Go Generic Soon". U.S.News & World Report.
    9. Jump up^ Eva Von Schaper (August 5, 2011). "Novartis's Jimenez Has Blockbuster Plans For Diovan After Patent Expires". Bloomberg.
    10. Jump up^ McMurray JJ, Holman RR, Haffner SM, et al. (April 2010). "Effect of valsartan on the incidence of diabetes and cardiovascular events" (PDF). The New England Journal of Medicine. 362 (16): 1477–90. doi:10.1056/NEJMoa1001121. PMID 20228403.
    11. Jump up^ Kjeldsen SE1, McInnes GT, Mancia G, Hua TA, Julius S, Weber MA, Coca A, Girerd X, Jamerson K, Larochelle P, Macdonald T, Schmieder RE, Anthony Schork M, Viskoper R, Widimsky J, Zanchetti A. "Progressive effects of valsartan compared with amlodipine in prevention of diabetes according to categories of diabetogenic risk in hypertensive patients: the VALUE trial". Blood Press. 17: 170–7. doi:10.1080/08037050802169644. PMID 18608200.
    12. Jump up^ Li NC, Lee A, Whitmer RA, et al. (January 2010). "Use of angiotensin receptor blockers and risk of dementia in a predominantly male population: prospective cohort analysis" (PDF). BMJ. 340: b5465. doi:10.1136/bmj.b5465. PMC 2806632 Freely accessible. PMID 20068258.
    13. Jump up^ "amlodipine and valsartan". Retrieved September 2, 2016.

    External links[edit]

    • Valsartan National Library of Medicine: Drug Information Portal