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Valsartan: Drug information

Valsartan: Drug information
(For additional information see "Valsartan: Patient drug information" and see "Valsartan: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
ALERT: US Boxed Warning
Fetal toxicity:

Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus. When pregnancy is detected, discontinue valsartan as soon as possible.

Brand Names: US
  • Diovan
Brand Names: Canada
  • Auro-Valsartan;
  • Diovan;
  • M-Valsartan;
  • SANDOZ Valsartan;
  • TARO-Valsartan;
  • TEVA-Valsartan
Pharmacologic Category
  • Angiotensin II Receptor Blocker;
  • Antihypertensive
Dosing: Adult

Dosage guidance:

Dosage form information: The commercially available oral solution and extemporaneously compounded oral suspension have greater bioavailability than tablets. All doses shown in this monograph are for the oral tablets. When converting to an oral liquid preparation, reassess dose.

Acute coronary syndrome

Acute coronary syndrome:

Note: Alternative in patients who cannot tolerate an angiotensin-converting enzyme (ACE) inhibitor (eg, due to cough) (Ref). In patients with prior ACE inhibitor–associated angioedema (ie, without urticaria or other signs of hypersensitivity), an angiotensin II receptor blocker (ARB) may still be an alternative. ARBs do not appear to elevate the risk of angioedema (Ref); however, patients must be educated that angioedema due to an ACE inhibitor can sometimes reoccur within months following discontinuation (Ref); referral to an allergist may be appropriate.

Non–ST-elevation acute coronary syndrome (alternative agent):

Note: Initiate in stable patients prior to hospital discharge as a component of an appropriate medical regimen, which may include antiplatelet agent(s), a beta-blocker, and a statin. Continue indefinitely for patients with concurrent diabetes, left ventricular ejection fraction ≤40%, hypertension, or stable chronic kidney disease (Ref).

Oral: Initial: 20 mg twice daily; may increase dose as tolerated up to 160 mg twice daily under close monitoring to avoid hypotension.

ST-elevation myocardial infarction (alternative agent):

Note: In hemodynamically stable patients with large anterior ST-elevation myocardial infarction, consider starting within 24 hours of presentation as a component of an appropriate medical regimen, which may include antiplatelet agent(s), a beta-blocker, and a statin. Continue therapy indefinitely (Ref).

Oral: Initial: 20 mg twice daily; may increase dose as tolerated up to 160 mg twice daily under close monitoring to avoid hypotension.

Heart failure with reduced ejection fraction

Heart failure with reduced ejection fraction (alternative agent):

Note: Alternative therapy in patients who cannot tolerate an angiotensin II receptor-neprilysin inhibitor (ARNI) or an ACE inhibitor (eg, due to cough or angioedema); consultation with a heart failure specialist and/or an allergist may be appropriate (Ref). ARBs do not appear to elevate the risk of angioedema (Ref); however, angioedema due to an ACE inhibitor can sometimes reoccur within months following discontinuation (Ref).

Oral: Initial: 20 to 40 mg twice daily; increase dose (eg, double) every ≥1 to 2 weeks based on response and tolerability to a target dose of 160 mg twice daily (Ref). In hospitalized patients, may titrate more rapidly as tolerated (Ref).

Hypertension, chronic

Hypertension, chronic:

Note: For patients who warrant combination therapy (BP >20/10 mm Hg above goal or suboptimal response to initial monotherapy), may use with another appropriate agent (eg, long-acting dihydropyridine calcium channel blocker or thiazide diuretic) (Ref).

Oral: Initial: 80 to 160 mg once daily; evaluate response after ~2 to 4 weeks and titrate dose (eg, increase the daily dose by doubling) as needed up to a maximum of 320 mg once daily; if additional blood pressure control is needed, consider combination therapy. Patients with severe asymptomatic hypertension and no signs of acute end organ damage should be evaluated for medication titration within 1 week (Ref). If the commercially available oral solution is used, the manufacturer labeling recommends administering the dose in 2 divided doses.

Proteinuric chronic kidney disease, diabetic or nondiabetic

Proteinuric chronic kidney disease, diabetic or nondiabetic (off-label use):

Oral: Initial: 80 to 160 mg once daily or in two divided doses depending on baseline BP; titrate gradually (eg, by doubling the dose every 2 to 4 weeks) up to the maximally tolerated dose, not to exceed 320 mg/day. If proteinuria target is not met despite optimized dosage, consider additional therapies (eg, sodium-glucose cotransporter-2 inhibitor) (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Altered kidney function: No dosage adjustment necessary for any degree of kidney dysfunction (Ref). Note: Use with caution in patients with kidney impairment (especially CrCl <30 mL/minute); monitor kidney function and potassium more closely (Ref).

Hemodialysis, intermittent (thrice weekly): Not significantly dialyzed (Ref): No supplemental dose or dosage adjustment necessary (Ref).

Peritoneal dialysis: Unlikely to be dialyzed (highly protein bound): No dosage adjustment necessary (Ref).

CRRT: No dosage adjustment necessary (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (Ref).

Dosing: Hepatic Impairment: Adult

Note: Should be used with caution in patients with ascites due to cirrhosis (Ref).

Mild to moderate impairment: No initial dosage adjustment necessary; use with caution.

Severe impairment: There are no dosage adjustments provided in the manufacturer's labeling; use with caution.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Valsartan: Pediatric drug information")

Hypertension

Hypertension:

Note: Oral dosage forms (tablets and compounded suspension) are not bioequivalent on a mg:mg basis. Due to increased bioavailability of extemporaneously prepared oral suspension, patients may require a higher dose when converting from oral suspension to tablet dosage form. Extemporaneously compounded oral suspension is recommended for patients ≤5 years of age and patients >5 years of age who are either unable to swallow tablets whole or their calculated dose (mg/kg) does not correspond to an available tablet strength (see "Extemporaneous Preparations").

Consider lower listed initial dose in patients with hyponatremia, hypovolemia, severe congestive heart failure, decreased renal function, or in those receiving diuretics.

Infants ≥6 months and weighing ≥6 kg: Limited data available; optimal dosage not defined: Oral: Extemporaneously compounded oral suspension was used in the trial: Initial: 1 mg/kg/dose once daily; titrate every 2 weeks to effect up to a maximum daily dose: 4 mg/kg/day; reported dosage range: 0.25 to 4 mg/kg/dose once daily; maximum daily dose: 4 mg/kg/day (Ref).

Children and Adolescents <17 years: Oral: Initial: 1 mg/kg/dose once daily; maximum initial daily dose: 40 mg/day; some patients may require a higher initial dose of 2 mg/kg/dose once daily. May titrate to effect up to a maximum daily dose: 4 mg/kg/day not to exceed 160 mg/day. Note: Obese pediatric patients 6 to 16 years were observed to respond at similar doses as nonobese (Ref).

Adolescents ≥17 years: Oral: Initial: 80 mg or 160 mg once daily; some patients may require a higher initial dose. May titrate to effect up to a maximum daily dose: 320 mg/day.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Children and Adolescents: Hypertensive pediatric patients may have associated renal abnormalities; monitor SCr and potassium closely in these patients; SCr may increase when initiating therapy.

CrCl ≥30 mL/minute/1.73 m2: No dosage adjustment necessary.

CrCl <30 mL/minute/1.73 m2: There are no dosage adjustments provided in the manufacturer's labeling; has not been studied; use with caution; valsartan use in chronic kidney disease undefined (Ref).

Dialysis: Not significantly removed.

Dosing: Hepatic Impairment: Pediatric

Children and Adolescents:

Mild to moderate impairment: No initial dosage adjustment necessary; use caution in patients with liver disease. Patients with mild to moderate chronic disease have twice the exposure as healthy volunteers.

Severe impairment: There are no dosage adjustments provided in manufacturer's labeling; has not been studied; use with caution.

Adverse Reactions (Significant): Considerations
Acute kidney injury

Valsartan may be associated with increased serum creatinine and/or acute kidney injury. Increases in serum creatinine secondary to angiotensin receptor blockers usually stabilize within 20% to 30% from baseline and are expected; additional increases may indicate renal artery stenosis or volume depletion (Ref).

Mechanism: Related to pharmacologic action; inhibits efferent renal arteriolar vasoconstriction, lowering glomerular filtration pressure which can lead to a modest reduction in glomerular filtration rate (GFR) (Ref).

Onset: Expected to be similar to angiotensin-converting enzyme inhibitors: Intermediate; transient increases in serum creatinine generally occur within 2 weeks initiation and stabilize within 2 to 4 weeks (Ref).

Risk factors:

• Sodium or volume depletion (Ref)

• Heart failure (Ref)

• Concurrent diuretic and/or nonsteroidal anti-inflammatory use (Ref)

• Older patients

• Hypotension (Ref)

• Preexisting kidney impairment (Ref)

• Patients with low renal blood flow (eg, renal artery stenosis) whose GFR is dependent on efferent arteriolar vasoconstriction by angiotensin II (Ref)

Hyperkalemia

Hyperkalemia may occur in adult and pediatric patients (Ref).

Mechanism: Related to the pharmacologic action; blocks angiotensin II from binding to the adrenal receptor and interferes with generation of angiotensin II within the adrenal cortex, decreasing aldosterone release and impairing renal potassium excretion (Ref).

Onset: Generally occurs within 1 week of treatment initiation (Ref).

Risk factors:

• High dietary intake of potassium (Ref)

• Baseline elevated potassium (≥5 mmol/L) (Ref)

• Older patients (Ref)

• Kidney dysfunction (Ref)

• Diabetes mellitus (Ref)

• Concurrent use of medications known to decrease renin and aldosterone (eg, direct renin inhibitors, nonsteroidal anti-inflammatory drugs, cyclosporine, tacrolimus, beta-blockers, sulfamethoxazole/trimethoprim, azole antifungals) (Ref)

• Concurrent use of potassium-sparing diuretics, potassium supplements, and/or potassium-containing salt substitutes (Ref)

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions reported in adults. Adverse reactions occurred with heart failure or post-MI unless otherwise indicated.

>10%:

Nervous system: Dizziness (17%; hypertension: 2% to 8%)

Renal: Increased blood urea nitrogen (>50% increase: 17%)

1% to 10%:

Cardiovascular: Hypotension (6% to 7%; hypertension: <1%), orthostatic dizziness (2%), orthostatic hypotension (2%), syncope (>1%; hypertension: <1%)

Endocrine & metabolic: Hyperkalemia (2%) (table 1)

Valsartan: Adverse Reaction: Hyperkalemia

Drug (Valsartan)

Placebo

Indication

Number of Patients (Valsartan)

Number of Patients (Placebo)

2%

1%

Heart failure

3,282

2,740

Gastrointestinal: Abdominal pain (hypertension: 2%), diarrhea (5%), nausea (>1%), upper abdominal pain (>1%)

Hematologic & oncologic: Neutropenia (2%)

Nervous system: Fatigue (3%; hypertension: 2%), headache (>1%), vertigo (>1%)

Neuromuscular & skeletal: Arthralgia (3%), back pain (3%)

Ophthalmic: Blurred vision (>1%)

Renal: Increased serum creatinine (4%) (table 2), renal insufficiency (>1%)

Valsartan: Adverse Reaction: Increased Serum Creatinine

Drug (Valsartan)

Comparator (Captopril)

Placebo

Indication

Number of Patients (Valsartan)

Number of Patients (Captopril)

Number of Patients (Placebo)

Comments

4%

N/A

0.9%

Heart failure

3,282

N/A

2,740

>50% Increase in creatinine

4%

3%

N/A

Post-myocardial infarction

4,885

4,879

N/A

Doubling of creatinine

Respiratory: Dry cough (hypertension: 3%)

Postmarketing:

Cardiovascular: Vasculitis

Dermatologic: Alopecia, bullous dermatitis (Gao 2021), lichenoid eruption (Gencoglan 2009), skin rash (Ozturk 2012)

Hematologic & oncologic: Thrombocytopenia

Hepatic: Hepatitis, increased liver enzymes

Hypersensitivity: Angioedema (Alhowary 2018, Kalra 2012)

Neuromuscular & skeletal: Rhabdomyolysis

Renal: Acute kidney injury

Contraindications

Hypersensitivity to valsartan or any component of the formulation; concomitant use with aliskiren in patients with diabetes mellitus.

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Canadian labeling: Additional contraindications (not in US labeling): Concomitant use with aliskiren in patients with moderate to severe kidney impairment (GFR <60 mL/minute/1.73 m2); pregnancy; breastfeeding.

Warnings/Precautions

Concerns related to adverse effects:

• Angioedema: Angiotensin II receptor antagonists (ARBs) do not appear to elevate the risk of angioedema (Rasmussen 2019; Toh 2012). Patients with a history of angioedema due to an angiotensin-converting enzyme inhibitor must be educated that sometimes there can be recurrence within months following discontinuation (Beltrami 2011). No matter the cause of angioedema, prolonged frequent monitoring is required, especially if tongue, glottis, or larynx are involved, as they are associated with airway obstruction. Discontinue therapy immediately if angioedema occurs. Aggressive early management is critical. IM administration of epinephrine may be necessary. Do not readminister the ARB to patients who experience angioedema from this medication.

• Hypotension: Symptomatic hypotension may occur upon initiation in patients who are salt- or volume-depleted (eg, those treated with high-dose diuretics); correct volume depletion prior to administration. This transient hypotensive response is not a contraindication to further treatment with valsartan.

Disease-related concerns:

• Aortic/mitral stenosis: Use with caution in patients with significant aortic/mitral stenosis.

• Ascites: Generally, avoid use in patients with ascites due to cirrhosis or refractory ascites; if use cannot be avoided in patients with ascites due to cirrhosis, monitor BP and kidney function carefully to avoid rapid development of kidney failure (AASLD [Runyon 2013]).

• Hepatic impairment: Use with caution in patients with hepatic impairment (exposure to valsartan is increased).

• Kidney impairment: Use with caution in patients with kidney impairment.

Special populations:

• Race/Ethnicity: In Black patients, the BP-lowering effects of ARBs may be less pronounced. The exact mechanism is not known; differences in the renin-angiotensin-aldosterone system, low renin levels, and salt sensitivity more commonly found in Black patients may contribute (Brewster 2013; Helmer 2018; manufacturer's labeling).

• Surgical patients: In patients on chronic ARB therapy, intraoperative hypotension may occur with induction and maintenance of general anesthesia; however, discontinuation of therapy prior to surgery is controversial. If continued preoperatively, avoidance of hypotensive agents during surgery is prudent (ACCF/AHA [Hillis 2011]). Based on current research and clinical guidelines in patients undergoing noncardiac surgery, continuing ARBs is reasonable in the perioperative period. If ARBs are held before surgery, it is reasonable to restart postoperatively as soon as clinically feasible (ACC/AHA [Fleisher 2014]).

Dosage form specific issues:

• Product interchangeability: The commercially available oral solution, extemporaneously compounded oral suspension, and tablets are not interchangeable with each other due to differences in pharmacokinetics; do not combine the 2 dosage forms to achieve the total dose.

• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated with hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Zar 2007).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Oral:

Generic: 4 mg/mL (120 mL)

Tablet, Oral:

Diovan: 40 mg [scored]

Diovan: 80 mg, 160 mg, 320 mg

Generic: 40 mg, 80 mg, 160 mg, 320 mg

Generic Equivalent Available: US

Yes

Pricing: US

Solution (Valsartan Oral)

4 mg/mL (per mL): $2.75 - $9.27

Tablets (Diovan Oral)

40 mg (per each): $9.28

80 mg (per each): $11.09

160 mg (per each): $11.93

320 mg (per each): $15.09

Tablets (Valsartan Oral)

40 mg (per each): $0.25 - $5.12

80 mg (per each): $0.29 - $6.12

160 mg (per each): $0.31 - $6.58

320 mg (per each): $0.37 - $8.32

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Diovan: 40 mg, 80 mg, 160 mg, 320 mg

Generic: 40 mg, 80 mg, 160 mg, 320 mg

Administration: Adult

Oral:

Oral solution: Administer consistently with regard to food because high-fat meals decrease AUC ~8% and Cmax ~44%.

Oral suspension: Shake well before use.

Tablets: Administer with or without food.

Administration: Pediatric

Oral: May be administered without regard to food; shake oral suspension well before use.

Missed dose: Take missed dose as soon as possible unless almost time for the next dose; do not double a dose to make up for a missed dose.

Use: Labeled Indications

Heart failure with reduced ejection fraction: Treatment of heart failure (NYHA class II to IV) in adults.

Hypertension, chronic: Management of hypertension in adults and pediatric patients ≥1 year of age (tablet) or ≥6 years of age (oral solution).

Post–myocardial infarction: Reduction of cardiovascular mortality in patients with left ventricular dysfunction or failure following myocardial infarction (MI) (eg, acute coronary syndromes such as ST-elevation MI or non–ST-elevation MI) in adults.

Use: Off-Label: Adult

Proteinuric chronic kidney disease, diabetic or nondiabetic

Medication Safety Issues
Sound-alike/look-alike issues:

Valsartan may be confused with losartan, Valstar, Valturna

Diovan may be confused with Zyban

International issues:

Diovan [US, Canada, and multiple international markets] may be confused with Dianben, a brand name for metformin [Spain]

Metabolism/Transport Effects

Substrate of MRP2, OATP1B1/1B3 (SLCO1B1/1B3)

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Aliskiren: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Aliskiren may enhance the hypotensive effect of Angiotensin II Receptor Blockers. Aliskiren may enhance the nephrotoxic effect of Angiotensin II Receptor Blockers. Management: Aliskiren use with ACEIs or ARBs in patients with diabetes is contraindicated. Combined use in other patients should be avoided, particularly when CrCl is less than 60 mL/min. If combined, monitor potassium, creatinine, and blood pressure closely. Risk D: Consider therapy modification

Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider therapy modification

Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Angiotensin II: Receptor Blockers may diminish the therapeutic effect of Angiotensin II. Risk C: Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: Angiotensin II Receptor Blockers may enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. Angiotensin II Receptor Blockers may increase the serum concentration of Angiotensin-Converting Enzyme Inhibitors. Management: Use of telmisartan and ramipril is not recommended. It is not clear if any other combination of an ACE inhibitor and an ARB would be any safer. Consider alternatives when possible. Monitor blood pressure, renal function, and potassium if combined. Risk D: Consider therapy modification

Antihepaciviral Combination Products: May increase the serum concentration of Valsartan. Management: Consider decreasing the valsartan dose and monitoring for evidence of hypotension and worsening renal function if these agents are used in combination. Risk D: Consider therapy modification

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy

Arginine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Asciminib: May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Brigatinib: May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents. Risk C: Monitor therapy

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Bromperidol: May diminish the hypotensive effect of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Risk X: Avoid combination

Dapoxetine: May enhance the orthostatic hypotensive effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Darolutamide: May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Dexmethylphenidate: May diminish the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy

Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Drospirenone-Containing Products: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Risk C: Monitor therapy

Eltrombopag: May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Encorafenib: May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Eplerenone: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Finerenone: Angiotensin II Receptor Blockers may enhance the hyperkalemic effect of Finerenone. Risk C: Monitor therapy

Flunarizine: May enhance the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy

Gemfibrozil: May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Heparin: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Heparins (Low Molecular Weight): May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Herbal Products with Blood Pressure Increasing Effects: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Herbal Products with Blood Pressure Lowering Effects: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy

Indoramin: May enhance the hypotensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Leflunomide: May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Leniolisib: May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Risk X: Avoid combination

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Foslevodopa. Risk C: Monitor therapy

Lithium: Angiotensin II Receptor Blockers may increase the serum concentration of Lithium. Management: Initiate lithium at lower doses in patients receiving an angiotensin II receptor blocker (ARB). Consider lithium dose reductions in patients stable on lithium therapy who are initiating an ARB. Monitor lithium concentrations closely when combined. Risk D: Consider therapy modification

Loop Diuretics: May enhance the hypotensive effect of Angiotensin II Receptor Blockers. Loop Diuretics may enhance the nephrotoxic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nicorandil: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: Angiotensin II Receptor Blockers may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Angiotensin II Receptor Blockers. The combination of these two agents may also significantly decrease glomerular filtration and renal function. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents (Topical): May diminish the therapeutic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider therapy modification

Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk C: Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Polyethylene Glycol-Electrolyte Solution: Angiotensin II Receptor Blockers may enhance the nephrotoxic effect of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor therapy

Potassium Salts: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Potassium-Sparing Diuretics: Angiotensin II Receptor Blockers may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy

Prazosin: Antihypertensive Agents may enhance the hypotensive effect of Prazosin. Risk C: Monitor therapy

Pretomanid: May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Ranolazine: May enhance the adverse/toxic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Silodosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Sodium Phosphates: Angiotensin II Receptor Blockers may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor therapy

Sparsentan: May enhance the adverse/toxic effect of Angiotensin II Receptor Blockers. Risk X: Avoid combination

Tacrolimus (Systemic): Angiotensin II Receptor Blockers may enhance the hyperkalemic effect of Tacrolimus (Systemic). Risk C: Monitor therapy

Terazosin: Antihypertensive Agents may enhance the hypotensive effect of Terazosin. Risk C: Monitor therapy

Teriflunomide: May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Tolvaptan: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Trimethoprim: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Trofinetide: May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Management: Avoid concurrent use with OATP1B1/1B3 substrates for which small changes in exposure may be associated with serious toxicities. Monitor for evidence of an altered response to any OATP1B1/1B3 substrate if used together with trofinetide. Risk D: Consider therapy modification

Urapidil: Antihypertensive Agents may enhance the hypotensive effect of Urapidil. Risk C: Monitor therapy

Voclosporin: May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Food Interactions

Food decreases tablet Cmax and AUC by 50% and 40%, respectively. Oral solution Cmax and AUC are decreased by ~44% and 8%, respectively, with a high-fat, high-calorie meal. Management: Administer consistently with regard to food.

Reproductive Considerations

Avoid use of an angiotensin II receptor blocker (ARB) in patients who may become pregnant and who are not using effective contraception (ADA 2021).

Medications considered acceptable for the treatment of chronic hypertension during pregnancy may generally be used in patients trying to conceive. ARBs are fetotoxic. Transition patients prior to conception to an agent preferred for use during pregnancy (ACC/AHA [Whelton 2018]; ACOG 2019; NICE 2019).

When an ARB is used for the treatment of proteinuric chronic kidney disease in patients who could become pregnant, discontinue use at the first positive pregnancy test (ADA 2021; Fakhouri 2022).

ARBs are not recommended for the treatment of heart failure in patients planning to become pregnant (AHA/ACC/HFSA [Heidenreich 2022]).

Pregnancy Considerations

Drugs that act on the renin-angiotensin system can cause injury and death to the developing fetus. Exposure to an angiotensin II receptor blocker (ARB) during the first trimester of pregnancy may be associated with an increased risk of fetal malformations (ACOG 2019; ESC [Regitz-Zagrosek 2018]). Following exposure during the second or third trimesters, drugs that act on the renin-angiotensin system are associated with oligohydramnios. Oligohydramnios, due to decreased fetal kidney function, may lead to fetal lung hypoplasia and skeletal malformations. Oligohydramnios may not appear until after an irreversible fetal injury has occurred. ARB use during pregnancy is also associated with anuria, hypotension, kidney failure, skull hypoplasia, and death in the fetus/neonate. Monitor infants exposed to an ARB in utero for hyperkalemia, hypotension, and oliguria. Exchange transfusions or dialysis may be required to reverse hypotension or improve renal function.

Chronic maternal hypertension is also associated with adverse events in the fetus/infant. Chronic maternal hypertension may increase the risk of birth defects, low birth weight, preterm delivery, stillbirth, and neonatal death. Actual fetal/neonatal risks may be related to the duration and severity of maternal hypertension. Untreated hypertension may also increase the risk of adverse maternal outcomes, including gestational diabetes, myocardial infarction, preeclampsia, stroke, and delivery complications (ACOG 2019).

Discontinue ARBs as soon as possible once pregnancy is detected. Agents other than an ARB are recommended for the treatment of chronic hypertension during pregnancy (ACOG 2019; ESC [Cífková 2020]; ESC [Regitz-Zagrosek 2018]; SOGC [Magee 2022]). Closely monitor patients exposed to an ARB during pregnancy with serial ultrasounds.

ARBs are not recommended for the treatment of heart failure or proteinuric chronic kidney disease during pregnancy (AHA/ACC/HFSA [Heidenreich 2022]; ESC [Regitz-Zagrosek 2018]; Fakhouri 2022).

Breastfeeding Considerations

It is not known if valsartan is present in breast milk.

Due to the potential for serious adverse reactions in the breastfed infant, breastfeeding is not recommended by the manufacturer. When treatment for hypertension is needed in a breastfeeding patient, consider use of an agent other than an angiotensin II receptor blocker (ESC [Cífková 2020]; NICE 2019).

Dietary Considerations

Avoid salt substitutes which contain potassium.

Monitoring Parameters

Blood pressure; serum electrolytes (eg, potassium [especially in patients on concomitant potassium-sparing diuretics, potassium supplements and/or potassium containing salts]); kidney function.

Mechanism of Action

Valsartan produces direct antagonism of the angiotensin II (AT2) receptors, unlike the ACE inhibitors. It displaces angiotensin II from the AT1 receptor and produces its blood pressure-lowering effects by antagonizing AT1-induced vasoconstriction, aldosterone release, catecholamine release, arginine vasopressin release, water intake, and hypertrophic responses. This action results in more efficient blockade of the cardiovascular effects of angiotensin II and fewer side effects than the ACE inhibitors.

Pharmacokinetics (Adult Data Unless Noted)

Note: Commercially available oral solution and extemporaneously compounded oral suspension are not therapeutically equivalent to the tablet formulation. For an equivalent dose, valsartan oral solution has 86% higher Cmax and 25% higher AUC compared to tablet formulation.

Onset of action: ~2 hours.

Duration: 24 hours.

Distribution: Vd: 17 L.

Protein binding: 95%, primarily albumin.

Metabolism: To inactive metabolite (valeryl 4-hydroxy valsartan).

Bioavailability: Tablet: 25% (range: 10% to 35%); Suspension (extemporaneously prepared): ~40% (~1.6 times more than tablet).

Half-life elimination:

Children 1 to 5 years: ~4 hours (Blumer 2009).

Children and Adolescents 6 to 16 years: ~5 hours (Blumer 2009).

Adults: ~6 hours; ~35% longer in elderly patients.

Time to peak, serum:

Children and Adolescents 1 to 16 years: Oral suspension: 2 hours (Blumer 2009).

Adults: Oral solution: 0.7 to 3.7 hours (high-fat, high-calorie meal decreased Cmax ~44%); Tablet: 2 to 4 hours.

Excretion: Feces (83%) and urine (~13%) as unchanged drug.

Clearance: Found to be similar per kg bodyweight in children vs adults receiving a single dose of the suspension (Blumer 2009).

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Hepatic function impairment: Patients with mild-to-moderate chronic liver disease have about twice the AUC value.

Older adult: AUC is about 70% higher and the half-life is 35% longer in elderly patients.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Angiovan | Arbaval | Diovan | Extenz | Joltan | Lova | Starval | Tabuvan | Valzar | Vanguard;
  • (AR) Argentina: Alpertan | Corosan | Diapresan | Dilcoran | Diovan | Diovan IC | Hiperval | Medicoran | Nicorvas | Paliax | Racorval | Redutensil | Sarval | Semanar | Simultan | Valsalep | Valsarfec | Valsartan northia | Valsartan teva | Vartaz;
  • (AT) Austria: Diovan | Valsacor | Valsartan +pharma | Valsartan 1A pharma | Valsartan actavis | Valsartan g.l. | Valsartan Genericon | Valsartan ratiopharm | Valsartan sandoz | Valsartan stada | Valsax;
  • (AU) Australia: Apo valsartan | Dilart | Diovan;
  • (BD) Bangladesh: Arovan | Cardival | Cardovan | Diovan | Disys | Reovan | Valcap | Valosan | Valpress | Valsan | Valset;
  • (BE) Belgium: Diovane | Valsamat | Valsamylan | Valsartan Apotex | Valsartan krka | Valsartan mylan | Valsartan Ranbaxy | Valsartan sandoz | Valsartan teva | Valsavil;
  • (BF) Burkina Faso: Starval | Valsar | Valsar denk | Valsartan win;
  • (BG) Bulgaria: Diovan | Nortivan | Nortivan neo | Sarteg | Sartoval | Suvartar | Valsacor | Valsalen | Valsarcon | Valsargamma | Valsavil | Valstor | Valtensin | Valzap | Vanatex | Vapress | Walzera;
  • (BR) Brazil: Angio II | Arterox | Aval | Brasart | Brator | Bravan | Cosartan | Diovan | Neosartan | Rovelan | Tamcore | Tareg | Valsacor | Valsartana | Valsartana eurofarma;
  • (CH) Switzerland: Diovan | Provas | Valsartan actavis | Valsartan axapharm | Valsartan Helvepharm | Valsartan sandoz | Valsartan Spirig | Valsartan Streuli | Valsartan zentiva | Valtan;
  • (CI) Côte d'Ivoire: Arbiten | Dopcor | Valex | Valmac | Valsar;
  • (CL) Chile: Dosara | Karga | Tamcore | Tareg | Valacor | Valaplex | Valax | Valkem | Valvitae | Vartalan | Veralpres;
  • (CN) China: Dai wen | Diovan | Jia fei | Lizhu weike | Mai xin | Sui yue | Ti tan wen | Tuo ping | Xie ke | Yi fang;
  • (CO) Colombia: Bratenzil | Cardik | Cardiotan | Clembroxol | Diovan | Presval | Racorval | Salvara | Valsad | Valsaprex | Valsarvitae | Valtan | Valutol | Varcor | Vartaz | Vasoflex;
  • (CZ) Czech Republic: Apo valsartan | Blessin | Diovan | Kylotan | Kylotan neo | Valsacor | Valsartan +pharma | Valsartan teva | Valzap | Vanatex | Vapress;
  • (DE) Germany: Cordinate | Diovan | Diovan emra med | Diovan protect | Diovane | Provas | Valsacor | Valsaraxiro | Valsargamma | Valsartan 1A pharma | Valsartan aaa | Valsartan actavis | Valsartan AL | Valsartan aurobindo | Valsartan Basics | Valsartan beta | Valsartan Biomo | Valsartan CT | Valsartan denk | Valsartan Dexcel | Valsartan Dura | Valsartan Hennig | Valsartan Heumann | Valsartan Hexal | Valsartan Hormosan | Valsartan Macleods | Valsartan puren | Valsartan Q | Valsartan ratiopharm | Valsartan stada | Valsartan zentiva;
  • (DK) Denmark: Diovan;
  • (DO) Dominican Republic: Acrovan | Alsartan | Atdos | Balsartec | Diovan | Gioten | Lodelip | Lysamol | Pexabrel | Terapres | Valchem | Valdiber | Valsacor | Valsar | Valsartan Genfar | Valsartan if | Valsartan Lam | Valsartan MK | Valsartan sued | Valsartec | Valscard | Valtan | Vartalan;
  • (EC) Ecuador: Atennor | Cardik | Cardik 320 | Diovan | Hiperval | Inixia c | Pertena | Simultan | Valaplex | Valopral | Valsapress | Valsartan La Sante | Valsartan MK | Vartalan | Vartaz;
  • (EE) Estonia: Diovan | Suvartar | Valsacor | Valsartan Medochemie | Valzap;
  • (EG) Egypt: Adwivalsar | Cardovaldon | Disartan | Idisartan | Lasaromep | Pressval | Sordevan | Tareg | Valsarcard;
  • (ES) Spain: Aralter | Diovan | Kalpress | Miten | Vals | Valsacor | Valsartan actavis | Valsartan almus | Valsartan alter | Valsartan Apotex | Valsartan aurobindo | Valsartan Cantabria | Valsartan cinfa | Valsartan combix | Valsartan Davur | Valsartan kern pharma | Valsartan krka | Valsartan Mabo | Valsartan Macleods | Valsartan mundogen | Valsartan mylan | Valsartan normon | Valsartan Pensa | Valsartan pharmagenus | Valsartan qualigen | Valsartan Ranbaxy | Valsartan ratiopharm | Valsartan sandoz | Valsartan stada | Valsartan tad | Valsartan Tarbis | Valsartan tecnigen | Valsartan teva | Valsartan zentiva;
  • (ET) Ethiopia: Anginet | Diovan | Tabuvan | Valazyd | Valsartan denk | Valsartan jubilant;
  • (FI) Finland: Diovan | Valsarstad | Valsartan actavis | Valsartan krka | Valsartan orion | Valsartan ratiopharm | Valsartan sandoz;
  • (FR) France: Diovan | Nisis | Tareg | Valsartan actavis | Valsartan ahcl | Valsartan alter | Valsartan Arrow | Valsartan biogaran | Valsartan Cristers | Valsartan EG | Valsartan evolugen | Valsartan isomed | Valsartan krka | Valsartan mylan | Valsartan Ranbaxy | Valsartan sandoz | Valsartan zentiva | Valsartan zydus;
  • (GB) United Kingdom: Diovan;
  • (GR) Greece: Avalsan | Dalzad | Diosartan | Diovan | Valperol | Valpressol | Valsaben | Valsareta | Valsart | Valsartan teva | Valsartan/Actavis | Valsartan/generics | Valsartan/krka | Valsartan/sandoz | Valsartan/Tad | Valsartan/teva | Vamadrid | Vartisan | Velsa | Zakodian;
  • (HK) Hong Kong: Apo valsartan | Diovan | Disys | Selectan | Syn valsartan | Valtensin;
  • (HR) Croatia: Desart | Diovan | Val | Valnorm | Valsacor | Walzera;
  • (HU) Hungary: Alvastran | Diovan | Nortivan | Tensart | Valsagamma | Valsarep | Valsartan krka | Valsartan sandoz | Valsartan teva | Valsocard | Valsotens | Varexan | Vezuran;
  • (ID) Indonesia: Diovan | Pavartan | Valsartan NI | Valtensi | Varten;
  • (IE) Ireland: Diovan | Valsartan krka | Valsartan rowa | Valtan | Vatan;
  • (IL) Israel: Diovan | Vector;
  • (IN) India: Diovan | Starval | Valembic | Valent | Valfect | Valzaar;
  • (IQ) Iraq: Diosartan | Valsartan awa;
  • (IT) Italy: Alsartir | Biorax | Kerval | Pressloval | Revalsan | Rixil | Sartarex | Saval | Tareg | Valpression | Valprex | Valsacor | Valsartan actavis | Valsartan almus | Valsartan alter | Valsartan Awp | Valsartan doc generici | Valsartan dr. Reddy's | Valsartan EG | Valsartan germed | Valsartan Macleods | Valsartan mylan | Valsartan Pensa | Valsartan provvisoria | Valsartan Ranbaxy | Valsartan sandoz | Valsartan tecnigen | Valsartan zentiva | Valsoten;
  • (JO) Jordan: Anginet | Arbiten | Diostar | Diotens | Diovan | Tabuvan | Valentine | Vapress | Vilasar;
  • (JP) Japan: Diovan | Valsartan "Nichi Iko" | Valsartan amel | Valsartan bmd | Valsartan chemiphar | Valsartan ee | Valsartan ffp | Valsartan isei | Valsartan jg | Valsartan kaken | Valsartan kn | Valsartan kog | Valsartan kyorin | Valsartan me | Valsartan meiji | Valsartan nipro | Valsartan nissin | Valsartan ohara | Valsartan tck | Valsartan teva | Valsartan towa | Valsartan tsuruhara | Valsartan yd | Valsartan zensei;
  • (KE) Kenya: Diovan | Starval | Troval | Valazyd | Valsar denk | Valtero;
  • (KR) Korea, Republic of: Auskovan | Binex valsartan | C rtan | Cirtan | Clovan | Detension | Dio v | Diopass | Diortan | Diorvan | Diosartan | Diotan | Diotech | Dioten | Diovaltan | Diovan | Diozartan | Diqvan | Dirotan | Dirtan | Disar | Divaltan | Dizantan | Dizantin | Dongkoo valsartan | Dsvan | Esaltan | Exvan | Hydn | Hyundai valsartan | Ilyangbio valsartan | Kovaltan | Maxdio | New valsartavan | Newsartan | Newvaltan | Sadivan | Samsung valsartan | Sarvaltan | Sarvan | Selectan | Tareg | Univaltan | V dio | V sar | V van | Valderid | Valmitan a | Valosartan | Valsabell | Valsan | Valsanin | Valsaone | Valsaor | Valsar | Valsarbell | Valsarect | Valsarotan | Valsartan bkw | Valsartel | Valsarvan | Valsatam | Valtaran | Valtrep | Vaotan | Varatan | Varban | Varetan | Vartan | Vasatan | Vzatan;
  • (KW) Kuwait: Anginet | Cinfaval | Diovan | Tabuvan;
  • (LB) Lebanon: Anginet | Arbiten | Diotens | Diovan | Reta | Tabuvan | Valpress | Valsartan arrow lab | Valustar | Valzap | Viostan;
  • (LT) Lithuania: Diovan | Suvartar | Valsacor | Valsartan actavis | Valsartan Ingen Pharma | Valsartan krka | Valsartan Ranbaxy | Valsartan sandoz | Valzap | Vanatex | Vapress;
  • (LU) Luxembourg: Diovan | Valsartan EG | Valsartan mylan | Valsartan ratiopharm;
  • (LV) Latvia: Diovan | Valsacor | Valsartan krka | Valzap | Vanatex | Vapress;
  • (MA) Morocco: Atensil | Starval | Tareg | Valphi | Vartex | Zenovan;
  • (MX) Mexico: Acavexal | Alphatempix | Avalraam | Diovalte | Diovan | Innaban | Menfhipress | Navoid | Novogaba | Panathra | Ragamat | Thorin | Travisfarox | Vactory | Vagsar | Valsartan novartis | Valsartan ultra | Valsauro | Vapispre | Versalver | Viecal | Vigisan | Vivendal;
  • (MY) Malaysia: Diovan | Valsartan sandoz | Valzaar | Vytan;
  • (NG) Nigeria: Acovan | Anginet | Carvals | Codiolad | Diovan | Dony valsartan | Lastavin | Nucard | Valdix | Valsar denk | Valsartil;
  • (NL) Netherlands: Diovan | Vagrecor | Valsartan actavis | Valsartan Erc | Valsartan jubilant | Valsartan krka | Valsartan mylan | Valsartan sandoz | Valsartan xiromed;
  • (NO) Norway: Diovan | Valsartan actavis | Valsartan krka | Valsartan mylan | Valsartan sandoz;
  • (PE) Peru: Angipec | Avan | Diovan | Presix | Pressix | Starval | Tensioval | Valsapress | Valsaprin | Valsartan calox | Valsarvitae | Valsiprel | Valtan | Valtens | Vapresan | Varside;
  • (PH) Philippines: Diovan | Dizant | Dizantin | Doh valsartan | Ritemed valsartan | Tareg | Torval | Trivan | Valazyd | Valsar | Valsolo | Valvex | Welcard;
  • (PK) Pakistan: Angiotan | C val | Converge | Cova | Dilval | Diovan | Listan | Nobel | Nuval | Sevia | Tulurik | Valforge | Valgen | Valid | Valken | Valmax | Valovan | Valpharm | Vals | Valsan | Valseta | Valstar | Valtec | Valtec high | Valtn | Varlan | Velcard | Velker | Velvet | Walsartan;
  • (PL) Poland: Anartan | Apo valsartan | Avasart | Awalone | Axudan | Bespres | Diovan | Dipper mono | Ivisart | Nortivan | Nortivan neo | Tensart | Valorion | Valsacor | Valsargen | Valsartan 123ratio | Valsartan Arrow | Valsartan aurobindo | Valsartan Aurovitas | Valsartan genoptim | Valsartan medical valley | Valsartan orion | Valsartan Ranbaxy | Valsotens | Valtap | Valzek | Vanatex | Walsartan krka | Zelvartan;
  • (PR) Puerto Rico: Diovan;
  • (PT) Portugal: Diovan | Molesart | Tareg | Valsartan actavis | Valsartan alter | Valsartan aurobindo | Valsartan baldacci | Valsartan Bluesar | Valsartan cinfa | Valsartan farmoz | Valsartan generis | Valsartan limeg | Valsartan mylan | Valsartan Pentafarma | Valsartan pharmacons | Valsartan pimentini | Valsartan ratiopharm | Valsartan sandoz | Valsartan stada | Valsartan tecnilor | Valsartan tetrafarma | Valsartan teva | Valsartan toLife | Valsartan zentiva;
  • (PY) Paraguay: Diovan | Europres | Valaplex | Valsartan bauel top | Vartalan;
  • (QA) Qatar: Anginet | Arbiten | Diostar | Diovan | Tabuvan | Valzaar | Vanguard;
  • (RO) Romania: Avassan | Coreton | Diovan | Valsacor | Valsargamma | Valsartan teva | Valsartan torrent | Valsartan zentiva | Vapress;
  • (RU) Russian Federation: Artinova | Diovan | Nortivan | Sartavel | Tantordio | Tareg | Valaar | Valsacor | Valsaforce | Valsartan akrikhin | Valsartan ms | Valsartan sz | Valsartan zentiva | Valz;
  • (SA) Saudi Arabia: Anginet | Arbaval | Arbiten | Diostar | Diovan | Tabuvan | Valista | Valtense;
  • (SE) Sweden: Diovan | Tanvacare | Valsartan 2care4 | Valsartan actavis | Valsartan ebb | Valsartan jubilant | Valsartan krka | Valsartan orion | Valsartan Ranbaxy | Valsartan sandoz | Valsartan teva | Valsartore | Valtsu;
  • (SG) Singapore: Diovan | Starval | Valsartan sandoz;
  • (SI) Slovenia: Diovan | Valsacor | Valsartan pliva | Valsartan teva | Valsotens;
  • (SK) Slovakia: Diovan | Valsacor | Valsargamma | Valsartan +pharma | Valsartan actavis | Valsartan krka | Valzap | Vapress | Vasopentol;
  • (TH) Thailand: Dioforge | Diovan | Tareg | Valatan | Valpres | Valsarin 160 | Valsarin 320;
  • (TN) Tunisia: Diostar | Reta | Tareg | Tazar | Tensiovals | Val | Valsartan Winthrop | Valsotens | Zarteg;
  • (TR) Turkey: Cardopan | Diovan | Limiten | Premium | Tamgard | Valcor | Wansaar;
  • (TW) Taiwan: Daianxo | Diovan | Disartan | Ditan | Diyaval | Kovan | Prevan | Retonin | Tareg | Vaks | Valazyd | Valen | Valsardin | Valsart | Vosaa;
  • (UA) Ukraine: Adeniz | Diocor solo | Diocor solo 160 | Diocor solo 80 | Diosar | Diovan | Sacord | Tiara solo | Valmisar | Valsacor | Valsar | Valsartan jubilant | Valsartan krka | Valsartan sandoz | Valsartan zentiva | Vasar;
  • (UG) Uganda: Anginet | Valazyd | Valsar;
  • (UY) Uruguay: Asortan | Diovan | Hipotensyl | Simultan | Valdix | Valopral | Valsacor | Valsartan athena | Valsartan Ion;
  • (VE) Venezuela, Bolivarian Republic of: Acavexal | Alsart | Brasart | Brasartan | Cofasure | Diovan | Ofadivan | Valpresan | Valsacor | Valsan | Vartaz | Vasaten;
  • (VN) Viet Nam: Doraval | Dovalic | Opevalsart | Rusartin | Valsacard | Valsarfast | Valsgim | Vasartim | Veesar;
  • (ZA) South Africa: Adco valsartan | Diolo | Diovan | Dynaval | Migroben | Regoval | Tareg | Valant | Valazyd | Valheft | Valsartan unicorn | Vasovan | Zomevek;
  • (ZM) Zambia: Diovan | Starval | Valzaar | Zomevek;
  • (ZW) Zimbabwe: Diovan | Dynaval | Valsar | Vasar
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