VALSARTAN (val-sar′tan) Diovan
Classifications: RENIN ANGIOTENSIN SYSTEM ANTAGONIST; ANTIHYPERTENSIVE
Therapeutic: ANTIHYPERTENSIVE; ANGIOTENSIN II RECEPTOR (AT1) ANTAGONIST
Prototype: Losartan
Pregnancy Category: D
AVAILABILITY
Capsule
ACTION & THERAPEUTIC EFFECT
An angiotensin II receptor (type AT1 receptor subtype) antagonist that blocks the angiotensin converting enzyme (ACE). It inhibits the binding of angiotensin II to the AT1 subtype receptors found in many tissues (e.g., vascular smooth muscle, adrenal glands). Angiotensin II is a potent vasoconstrictor and primary vasoactive hormone of the renin–angiotensin– aldosterone system (RAAS). Blocking angiotensin II receptors results in vasodilation as well as decreasing the aldosterone-secreting effects of angiotensin II. These actions result in the antihypertensive effect of valsartan.
USES
Treatment of hypertension, heart failure.
CONTRAINDICATIONS
Hypersensitivity to valsartan or losartan; severe heart failure with compromised renal function; volume depletion; history of ACE inhibitor–induced angioedema; children with CrCl of 30 mL/min/1.73 mm3; pregnancy (category D), lactation.
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| Nursing Implications for Valsartan Diovan |
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CAUTIOUS USE
Severe renal impairment; hyperuricemia; hyperglycemia; increases in cholesterol and triglycerides; acute angleclosure glaucoma; SLE; history of allergy or bronchial asthma; mild to moderate hepatic impairment; biliary stenosis; renal artery stenosis; hypovolemia; hyperkalemia; transient hypotension; use prior to surgery; history of angioedema; congestive heart failure; older adults; children younger than 6 y.
ROUTE & DOSAGE
Hypertension
Adult: PO 80 or 160 mg daily (max: 320 mg daily) Adolescent/Child (6–16 y): PO 1.3 mg/kg (up to 40 mg/day)
Heart Failure
Adult: PO Start with 40 mg b.i.d. and titrate up to 160 mg b.i.d.
Hemodialysis Dosage Adjustment
Adjustment not needed
ADMINISTRATION
Oral
- Give on an empty stomach.
- Correct volume depletion prior to initiation of therapy to prevent hypotension.
- Reduce dosage with severe hepatic or renal impairment.
- Note: Daily dose may be titrated up to 320 mg.
- Store at 15°–30° C (59°–86° F).
ADVERSE EFFECTS (≥1%)
Body as a Whole: Arthralgia. CNS: Headache, dizziness. GI: Diarrhea, nausea. Respiratory: Cough, sinusitis. Metabolic: Hyperkalemia.
PHARMACOKINETICS
Absorption: Rapidly from GI tract, 25% bioavailability. Onset: Blood pressure decreased in 2 wk. Peak: Plasma levels, 2–4 h; blood pressure effect 4 wk. Distribution: 99% protein bound. Metabolism: In the liver. Elimination: Primarily in feces. Half-Life: 6 h.
NURSING IMPLICATIONS
Black Box Warning
Valsartan has been associated with fetal toxicity.
Assessment & Drug Effects
- Monitor BP periodically; take trough readings, just prior to the next scheduled dose, when possible.
- Montior lab tests: Periodic LFTs, BUN and creatinine, serum potassium, and CBC with differential.
Patient & Family Education
- Inform prescriber immediately if you become pregnant.
- Note: Maximum pressure lowering effect is usually evident between 2 and 4 wk after initiation of therapy.
- Notify prescriber of episodes of dizziness, especially those that occur when making position changes.
- Do not use potassium supplements or salt substitutes containing potassium without consulting the prescribing prescriber.
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