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Valsartan and amlodipine: Drug information

Valsartan and amlodipine: Drug information
2025© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Valsartan and amlodipine: Patient drug information"

For abbreviations, symbols, and age group definitions show table
ALERT: US Boxed Warning
Fetal toxicity:

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

Brand Names: US
  • Exforge
Pharmacologic Category
  • Angiotensin II Receptor Blocker;
  • Antianginal Agent;
  • Antihypertensive;
  • Calcium Channel Blocker;
  • Calcium Channel Blocker, Dihydropyridine
Dosing: Adult

Note: Dose must be individualized.

Hypertension

Hypertension: Oral:

Initial therapy: Amlodipine 5 mg/valsartan 160 mg once daily; dose may be titrated after 1 to 2 weeks. Maximum dose: amlodipine 10 mg/valsartan 320 mg once daily

Add-on therapy: Amlodipine 5 to 10 mg/valsartan 160 to 320 mg once daily; dose may be titrated after 3 to 4 weeks of therapy. Maximum dose: amlodipine 10 mg/valsartan 320 mg once daily

Replacement therapy: Substitute for the individually titrated components. Maximum dose: amlodipine 10 mg/valsartan 320 mg once daily

Dosing: Kidney Impairment: Adult

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

CrCl <30 mL/minute: There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. Use with caution; titrate slowly. Not recommended for initial therapy in patients with hepatic impairment (recommended initial dose of amlodipine [2.5 mg/day] in these patients is not available in this combination product). Use with caution in patients with ascites due to cirrhosis (Ref).

Dosing: Older Adult

Not recommended for initial therapy (recommended initial dose of amlodipine [2.5 mg/day] in these patients is not available in this combination product). Use of lower doses should be considered. Refer to adult dosing.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Also see individual agents.

1% to 10%:

Cardiovascular: Peripheral edema (5%)

Central nervous system: Dizziness (2%)

Renal: Increased blood urea nitrogen (6%)

Respiratory: Nasopharyngitis (4%), upper respiratory tract infection (3%)

<1%: Hypotension, orthostatic dizziness, orthostatic hypotension, severe hypotension

Frequency not defined:

Central nervous system: Vertigo

Contraindications

Hypersensitivity to amlodipine, 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.

Warnings/Precautions

Concerns related to adverse effects:

• Angioedema: Angioedema has been reported rarely with some angiotensin II receptor antagonists (ARBs) and may occur at any time during treatment (especially following first dose). It may involve the head and neck (potentially compromising airway) or the intestine (presenting with abdominal pain). Patients with idiopathic or hereditary angioedema or previous angioedema associated with ACE-inhibitor therapy may be at an increased risk. Prolonged frequent monitoring may be required, especially if tongue, glottis, or larynx are involved, as they are associated with airway obstruction. Patients with a history of airway surgery may have a higher risk of airway obstruction. Discontinue therapy immediately if angioedema occurs. Aggressive early management is critical. Intramuscular (IM) administration of epinephrine may be necessary. Do not readminister to patients who have had angioedema with ARBs.

• Angina/MI: Increased angina and/or MI has occurred with initiation or dosage titration of dihydropyridine calcium channel blockers. Reflex tachycardia may occur resulting in angina and/or MI in patients with obstructive coronary disease, especially in the absence of concurrent beta-blockade.

• Hyperkalemia: May occur with valsartan use; risk factors include renal dysfunction, diabetes mellitus, concomitant use of potassium-sparing diuretics, potassium supplements, and/or potassium-containing salts. Use cautiously, if at all, with these agents and monitor potassium closely.

• 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 amlodipine/valsartan.

• Hypotension/syncope: Symptomatic hypotension with or without syncope can rarely occur; use caution during initiation of therapy, particularly in patients with heart failure, severe aortic stenosis, or in post-MI patients or those undergoing surgery or dialysis.

• Peripheral edema: The most common side effect of amlodipine is peripheral edema; occurs within 2-3 weeks of starting therapy.

• Renal function deterioration: Valsartan may be associated with deterioration of renal function and/or increases in serum creatinine, particularly in patients with low renal blood flow (eg, renal artery stenosis, heart failure) whose glomerular filtration rate (GFR) is dependent on efferent arteriolar vasoconstriction by angiotensin II; deterioration may result in oliguria, acute renal failure, and progressive azotemia. Small increases in serum creatinine may occur following initiation; consider discontinuation only in patients with progressive and/or significant deterioration in renal function.

Disease-related concerns:

• Aortic stenosis: Use amlodipine with extreme caution in patients with severe aortic stenosis; may reduce coronary perfusion resulting in ischemia.

• 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 renal function carefully to avoid rapid development of renal failure (AASLD [Runyon 2013]).

• Heart failure: Use caution when initiating in heart failure; may need to adjust dose, and/or concurrent diuretic therapy.

• Hepatic impairment: Use with caution in patients with hepatic impairment; amlodipine and valsartan exposure increases with hepatic dysfunction.

• Hypertrophic cardiomyopathy (HCM) with outflow tract obstruction: Use amlodipine with caution in patients with HCM and outflow tract obstruction since reduction in afterload may worsen symptoms associated with this condition.

• Renal artery stenosis: Use valsartan with caution in patients with unstented unilateral/bilateral renal artery stenosis. When unstented bilateral renal artery stenosis is present, use is generally avoided due to the elevated risk of deterioration in renal function unless possible benefits outweigh risks.

• Renal impairment: Use with caution with preexisting renal insufficiency and severe renal impairment.

Concurrent drug therapy issues:

• Angiotensin-converting enzyme (ACE) inhibitors and renin inhibitors: Concomitant use of an ACE-inhibitor or renin inhibitor (eg, aliskiren) is associated with an increased risk of hypotension, hyperkalemia, and renal dysfunction. Concomitant use with aliskiren should be avoided in patients with GFR <60 mL/minute and is contraindicated in patients with diabetes mellitus (regardless of GFR).

Special populations:

• Older adult: Exposure to amlodipine is increased in the elderly; consider use of a lower initial dose.

• Pregnancy: [US Boxed Warning]: Drugs that act on the renin-angiotensin system can cause injury and death to the developing fetus. Discontinue as soon as possible once pregnancy is detected.

• Surgical patients: In patients on chronic angiotensin receptor blocker (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 (Hillis, 2011).

Dosage Forms: US

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

Tablet, Oral:

Exforge: Amlodipine 5 mg and valsartan 160 mg, Amlodipine 5 mg and valsartan 320 mg, Amlodipine 10 mg and valsartan 160 mg, Amlodipine 10 mg and valsartan 320 mg

Generic: Amlodipine 10 mg and valsartan 160 mg, Amlodipine 10 mg and valsartan 320 mg, Amlodipine 5 mg and valsartan 160 mg, Amlodipine 5 mg and valsartan 320 mg

Generic Equivalent Available: US

Yes

Pricing: US

Tablets (amLODIPine Besylate-Valsartan Oral)

5-160 mg (per each): $5.46 - $5.47

5-320 mg (per each): $6.93 - $6.94

10-160 mg (per each): $6.20

10-320 mg (per each): $7.86 - $7.87

Tablets (Exforge Oral)

5-160 mg (per each): $12.96

5-320 mg (per each): $16.44

10-160 mg (per each): $14.70

10-320 mg (per each): $18.66

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.

Administration: Adult

Administer with or without food.

Use: Labeled Indications

Hypertension: Management of hypertension (monotherapy or in combination with other antihypertensives). See individual monographs.

Metabolism/Transport Effects

Refer to individual components.

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 drug interactions program by clicking on the “Launch drug interactions program” link above.

Alfuzosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Aliskiren: May increase nephrotoxic effects of Angiotensin II Receptor Blockers. Aliskiren may increase hyperkalemic effects of Angiotensin II Receptor Blockers. Aliskiren may increase hypotensive effects 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

ALPRAZolam: CYP3A4 Inhibitors (Weak) may increase serum concentration of ALPRAZolam. Risk C: Monitor

Amifostine: Blood Pressure Lowering Agents may increase hypotensive effects 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 decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Angiotensin II: Angiotensin II Receptor Blockers may decrease therapeutic effects of Angiotensin II. Risk C: Monitor

Angiotensin-Converting Enzyme Inhibitors: Angiotensin II Receptor Blockers may increase adverse/toxic effects of Angiotensin-Converting Enzyme Inhibitors. Angiotensin II Receptor Blockers may increase 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 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 increase hypotensive effects of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor

Arginine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

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

Atosiban: Calcium Channel Blockers may increase adverse/toxic effects of Atosiban. Specifically, there may be an increased risk for pulmonary edema and/or dyspnea. Risk C: Monitor

Barbiturates: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Belumosudil: May increase serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Management: Avoid coadministration of belumosudil with these substrates of OATP1B1/1B3 for which minimal concentration increases can cause serious adverse effects. If coadministration is required, dose reductions of the OATP1B1/1B3 substrate may be required. Risk D: Consider Therapy Modification

Benperidol: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Brigatinib: May decrease antihypertensive effects of Antihypertensive Agents. Brigatinib may increase bradycardic effects of Antihypertensive Agents. Risk C: Monitor

Brimonidine (Topical): May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Bromperidol: May decrease hypotensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase hypotensive effects of Bromperidol. Risk X: Avoid

Bulevirtide: May increase serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Management: Coadministration of bulevirtide with OATP1B1/1B3 (also known as SLCO1B1/1B3) substrates should be avoided when possible. If used together, close clinical monitoring is recommended. Risk D: Consider Therapy Modification

Calcium Salts: May decrease therapeutic effects of Calcium Channel Blockers. Risk C: Monitor

CarBAMazepine: CYP3A4 Inhibitors (Weak) may increase serum concentration of CarBAMazepine. Risk C: Monitor

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

Charcoal, Activated: May decrease serum concentration of AmLODIPine. Risk C: Monitor

Clofazimine: May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor

CycloSPORINE (Systemic): Calcium Channel Blockers (Dihydropyridine) may increase serum concentration of CycloSPORINE (Systemic). CycloSPORINE (Systemic) may increase serum concentration of Calcium Channel Blockers (Dihydropyridine). Risk C: Monitor

CYP3A4 Inducers (Moderate): May decrease serum concentration of AmLODIPine. Risk C: Monitor

CYP3A4 Inducers (Strong): May decrease serum concentration of AmLODIPine. Risk C: Monitor

CYP3A4 Inhibitors (Moderate): May increase serum concentration of AmLODIPine. Risk C: Monitor

CYP3A4 Inhibitors (Strong): May increase serum concentration of AmLODIPine. Risk C: Monitor

Dantrolene: May increase hyperkalemic effects of Calcium Channel Blockers. Dantrolene may increase negative inotropic effects of Calcium Channel Blockers. Risk X: Avoid

Dapoxetine: May increase orthostatic hypotensive effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Dapoxetine: May increase orthostatic hypotensive effects of Calcium Channel Blockers. Risk C: Monitor

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

Dexmethylphenidate: May decrease therapeutic effects of Antihypertensive Agents. Risk C: Monitor

Diazoxide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Dipeptidyl Peptidase-IV Inhibitors: May increase adverse/toxic effects of Angiotensin II Receptor Blockers. Specifically, the risk for angioedema may be increased with this combination. Risk C: Monitor

Drospirenone-Containing Products: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

DULoxetine: Blood Pressure Lowering Agents may increase hypotensive effects of DULoxetine. Risk C: Monitor

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

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

Finerenone: Angiotensin II Receptor Blockers may increase hyperkalemic effects of Finerenone. Risk C: Monitor

Finerenone: CYP3A4 Inhibitors (Weak) may increase serum concentration of Finerenone. Risk C: Monitor

Flibanserin: CYP3A4 Inhibitors (Weak) may increase serum concentration of Flibanserin. Risk C: Monitor

Flunarizine: May increase therapeutic effects of Antihypertensive Agents. Risk C: Monitor

Fusidic Acid (Systemic): May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Consider avoiding this combination if possible. If required, monitor patients closely for increased adverse effects of the CYP3A4 substrate. Risk D: Consider Therapy Modification

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

Heparin: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Heparins (Low Molecular Weight): May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Herbal Products with Blood Pressure Increasing Effects: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Herbal Products with Blood Pressure Lowering Effects: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Hypotension-Associated Agents: Blood Pressure Lowering Agents may increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor

Iloperidone: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Indoramin: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Inhalational Anesthetics: May increase hypotensive effects of Calcium Channel Blockers. Risk C: Monitor

Isocarboxazid: May increase antihypertensive effects of Antihypertensive Agents. Risk X: Avoid

Ixabepilone: CYP3A4 Inhibitors (Weak) may increase serum concentration of Ixabepilone. Risk C: Monitor

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

Lemborexant: CYP3A4 Inhibitors (Weak) may increase serum concentration of Lemborexant. Management: The maximum recommended dosage of lemborexant is 5 mg, no more than once per night, when coadministered with weak CYP3A4 inhibitors. Risk D: Consider Therapy Modification

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

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may increase hypotensive effects of Levodopa-Foslevodopa. Risk C: Monitor

Lithium: Angiotensin II Receptor Blockers may increase 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

Lomitapide: CYP3A4 Inhibitors (Weak) may increase serum concentration of Lomitapide. Management: Patients on lomitapide 5 mg/day may continue that dose. Patients taking lomitapide 10 mg/day or more should decrease the lomitapide dose by half. The lomitapide dose may then be titrated up to a max adult dose of 30 mg/day. Risk D: Consider Therapy Modification

Loop Diuretics: May increase hypotensive effects of Angiotensin II Receptor Blockers. Loop Diuretics may increase nephrotoxic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Loop Diuretics: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Lormetazepam: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Lovastatin: AmLODIPine may increase serum concentration of Lovastatin. Risk C: Monitor

Magnesium Sulfate: May increase adverse/toxic effects of Calcium Channel Blockers (Dihydropyridine). Specifically, the risk of hypotension or muscle weakness may be increased. Risk C: Monitor

Melatonin: May decrease antihypertensive effects of Calcium Channel Blockers (Dihydropyridine). Risk C: Monitor

Metergoline: May decrease antihypertensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase orthostatic hypotensive effects of Metergoline. Risk C: Monitor

Methylphenidate: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Midazolam: CYP3A4 Inhibitors (Weak) may increase serum concentration of Midazolam. Risk C: Monitor

Molsidomine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Naftopidil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Neuromuscular-Blocking Agents (Nondepolarizing): Calcium Channel Blockers may increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor

Nicergoline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nicorandil: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Nicorandil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

NiMODipine: CYP3A4 Inhibitors (Weak) may increase serum concentration of NiMODipine. Risk C: Monitor

Nitroprusside: Blood Pressure Lowering Agents may increase hypotensive effects of Nitroprusside. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents (Topical): May decrease therapeutic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

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

Obinutuzumab: May increase hypotensive effects 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 increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Perazine: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Pholcodine: Blood Pressure Lowering Agents may increase hypotensive effects of Pholcodine. Risk C: Monitor

Phosphodiesterase 5 Inhibitors: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Pimozide: CYP3A4 Inhibitors (Weak) may increase serum concentration of Pimozide. Risk X: Avoid

Polyethylene Glycol-Electrolyte Solution: Angiotensin II Receptor Blockers may increase nephrotoxic effects of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor

Potassium Salts: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Potassium-Sparing Diuretics: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Prazosin: Antihypertensive Agents may increase hypotensive effects of Prazosin. Risk C: Monitor

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

Prostacyclin Analogues: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Quinagolide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Ranolazine: May increase adverse/toxic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Red Yeast Rice: AmLODIPine may increase serum concentration of Red Yeast Rice. Risk C: Monitor

Sacubitril: Angiotensin II Receptor Blockers may increase adverse/toxic effects of Sacubitril. Risk X: Avoid

Silodosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Simvastatin: AmLODIPine may increase serum concentration of Simvastatin. Management: Dose of simvastatin should not exceed 20 mg daily if coadministering with amlodipine. If coadministering with simvastatin and amlodipine, close laboratory and clinical monitoring for signs and symptoms of rhabdomyolysis is warranted. Risk D: Consider Therapy Modification

Sincalide: Drugs that Affect Gallbladder Function may decrease therapeutic effects of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. Risk D: Consider Therapy Modification

Sirolimus (Conventional): CYP3A4 Inhibitors (Weak) may increase serum concentration of Sirolimus (Conventional). Risk C: Monitor

Sirolimus (Protein Bound): CYP3A4 Inhibitors (Weak) may increase serum concentration of Sirolimus (Protein Bound). Management: Reduce the dose of protein bound sirolimus to 56 mg/m2 when used concomitantly with a weak CYP3A4 inhibitor. Risk D: Consider Therapy Modification

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

Sparsentan: May increase adverse/toxic effects of Angiotensin II Receptor Blockers. Risk X: Avoid

Tacrolimus (Systemic): Angiotensin II Receptor Blockers may increase hyperkalemic effects of Tacrolimus (Systemic). Risk C: Monitor

Tacrolimus (Systemic): Calcium Channel Blockers (Dihydropyridine) may increase serum concentration of Tacrolimus (Systemic). Risk C: Monitor

Tacrolimus (Systemic): CYP3A4 Inhibitors (Weak) may increase serum concentration of Tacrolimus (Systemic). Risk C: Monitor

Terazosin: Antihypertensive Agents may increase hypotensive effects of Terazosin. Risk C: Monitor

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

Tolvaptan: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Triazolam: CYP3A4 Inhibitors (Weak) may increase serum concentration of Triazolam. Risk C: Monitor

Trimethoprim: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Trofinetide: May increase 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

Ubrogepant: CYP3A4 Inhibitors (Weak) may increase serum concentration of Ubrogepant. Management: In patients taking weak CYP3A4 inhibitors, the initial and second dose (given at least 2 hours later if needed) of ubrogepant should be limited to 50 mg. Risk D: Consider Therapy Modification

Urapidil: Antihypertensive Agents may increase hypotensive effects of Urapidil. Risk C: Monitor

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

Food Interactions

See individual agents.

Pregnancy Considerations

[US Boxed Warning]: Drugs that act on the renin-angiotensin system can cause injury and death to the developing fetus. Discontinue as soon as possible once pregnancy is detected. See individual agents.

Breastfeeding Considerations

Amlodipine is present in breast milk (Naito 2015); excretion of valsartan is unknown.

Because of the potential for serious adverse reactions in the breastfed infant, breastfeeding is not recommended by the manufacturer. See individual agents.

Dietary Considerations

Avoid salt substitutes which contain potassium.

Monitoring Parameters

Blood pressure, heart rate; baseline and periodic electrolyte panels; renal and liver function; monitor for orthostasis, peripheral edema

Mechanism of Action

Amlodipine inhibits calcium ion from entering the “slow channels” or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation; increases myocardial oxygen delivery in patients with vasospastic angina. Amlodipine directly acts on vascular smooth muscle to produce peripheral arterial vasodilation reducing peripheral vascular resistance and blood pressure.

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)

See individual agents.

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

  • (AE) United Arab Emirates: Coamvasc | Imprida | Lodiva | Lotevan | Obrexa | Wamlox;
  • (AR) Argentina: Diapresan a | Diovan A | Disarval | Exforge | Noster | Simultan a;
  • (AT) Austria: Amlodipin / Valsartan Zentiva | Amlodipin/valsartan 1a pharma | Amlodipin/Valsartan Actavis | Amlodipin/valsartan genericon | Amlodipin/valsartan krka | Amlodipin/valsartan sandoz | Amlodipin/valsartan stada | Amlovalsax;
  • (AU) Australia: Exforge | Valsart/amlodipine sandoz | Valsartan/amlodipine novartis;
  • (BD) Bangladesh: Amlosartan | Amlovas Vs | Camoval | Co disys | Co valtin | Exforge;
  • (BE) Belgium: Amlodipine/valsartan EG | Amlodipine/valsartan krka | Amlodipine/valsartan sandoz | Exforge;
  • (BG) Bulgaria: Amlodipine/valsartan sandoz | Amvalcon | Asbima | Dipperam | Valsavil am | Valtensam | Wamlox;
  • (BR) Brazil: Brasart bcc | Cosartan alp | Diovan amlo | Valsartana + anlodipino;
  • (CH) Switzerland: Amlodip valsartan mylan | Amlodipin valsartan sandoz | Amlodipin Valsartan Zentiva | Exforge | Valsartan amlo spirig hc;
  • (CI) Côte d'Ivoire: Valamlo;
  • (CL) Chile: Exforge | Valaxam | Vartalan am;
  • (CN) China: Bei bo te | Valsartan and amlodipine;
  • (CO) Colombia: Alpex duoval | Amlodipino + valsartan | Ampliron | Duoval | Exforge | Garmisch duoval | Valsartan+amlodipino | Valsartan/Amlodipino;
  • (CZ) Czech Republic: Wamlox;
  • (DE) Germany: Amlo valsacor | Amlodipin valsartan beta | Amlodipin Valsartan Zentiva | Amlodipin/valsartan 1 a pharma | Amlodipin/valsartan abz | Amlodipin/valsartan accord | Amlodipin/Valsartan AL | Amlodipin/valsartan denk | Amlodipin/valsartan heumann | Amlodipin/valsartan mylan | Amlodipin/valsartan puren | Amlodipin/Valsartan ratiopharm | Amlodipine/valsartan | Copalia | Dafiro | Epiaosan | Exforge | Valsimia;
  • (DO) Dominican Republic: Amapine v | Aremis | Atdos a | Diloben | Forzapress | Gioten a | Lysamol a | Valdiber a | Valodipin | Valodipin plus | Valsar A | Valsartec a | Valscard a | Vartalan am;
  • (EC) Ecuador: Cardik a | Exforge | Hiperval am | Simultan a | Valaxam;
  • (EE) Estonia: Amlodipine/valsartan sandoz | Exforge | Wamlox;
  • (EG) Egypt: Alkapress Plus | Amilo plus | Avivavasc | Blokatens | Exforge | Kemiforge | Molivart | Nexpress | Zetakardoval;
  • (ES) Spain: Amlodipin/valsartan tecnigen | Amlodipino/Valsartan Aurovitas | Amlodipino/valsartan cinfamed | Amlodipino/valsartan kern pharma | Amlodipino/valsartan krka | Amlodipino/valsartan Mylan | Amlodipino/valsartan ratiopharm | Amlodipino/valsartan sandoz | Amlodipino/valsartan stada | Amlodipino/valsartan teva | Dafiro | Imprida | Valsimia;
  • (ET) Ethiopia: Amlodipine and valsartan | Exforge;
  • (FI) Finland: Amlodipin/valsartan krka | Amlodipin/valsartan orion | Amlodipin/Valsartan ratiopharm | Amlodipin/valsartan stada | Amlodipine/valsartan Mylan | Exforge;
  • (FR) France: Amlodipine/Valsartan accord | Amlodipine/valsartan arrow | Amlodipine/valsartan cristers | Amlodipine/valsartan EG | Amlodipine/valsartan evolugen | Amlodipine/valsartan krka | Amlodipine/valsartan Mylan | Amlodipine/valsartan sandoz | Amlodipine/valsartan teva | Amlodipine/valsartan zentiva | Amlodipine/valsartan zydus | Exforge;
  • (GB) United Kingdom: Amlodipine/valsartan | Exforge;
  • (GR) Greece: Alvoda | Copalia | Covadir | Exforge | Valsimia;
  • (HK) Hong Kong: Nikp amlodipine/valsartan | Norvan;
  • (HR) Croatia: Amlodipin/valsartan Pliva | Amlodipin/valsartan sandoz | Exforge | Vainas | Wamlox;
  • (HU) Hungary: Amlodipine/valsartan sandoz | Wamlox;
  • (ID) Indonesia: Exforge | Lapiva | Vardipin;
  • (IE) Ireland: Amlodipine/valsartan clonmel | Amlodipine/valsartan krka | Amlodipine/valsartan Mylan | Amlodipine/valsartan Rowex | Exforge;
  • (IL) Israel: Duplex | Exforge;
  • (IN) India: Amlopres VL | Exforge | Valembic am;
  • (IT) Italy: Asbima | Cantensio | Dipperam;
  • (JO) Jordan: Exforge | Lotevan | Newstar | Senergy;
  • (JP) Japan: Amvalo | Exforge Combination;
  • (KE) Kenya: Amva denk | Avsar | Exforge | Starval am | Valembic am | Valvas;
  • (KR) Korea, Republic of: Aforge | Alfaforge | Amdisar | Amiforge | Amlosartan | Amlotan | Amlovaltan | Amlovan | Amortan | Amvalsan | Amvalt | Amvaltan | Amvartan | Amvasartan | Anafurge | Anoforge | Anyforge | Arb xg | Avaltan | Avartan | Avastar | Besforge | Biforge | Cadenza | Cardiforge | Cellt forge | Cesmutan | Citforge | Combiforge | Conex | Corforge | Crb | Ctforge | Diodipine | Dionova | Diroforge | Disforge | Doubleforge | Dual down | Dual x | Dualforge | Duoforge | Ex v | Exadipine | Excombi | Exdipin | Exduo | Exfall | Exforge | Exforte | Exfos | Exivitan | Exlopine | Exnin | Exone | Exparall | Expin | Expine | Expintan | Expo g | Exrobin | Exvaltan | Glofoge | Gloforge | Hiforge | Huniz valsarpin | Imprida | Infosge | J tension | Jeiforge | Jforge | Logis | Lowforge | Maxforge | Mediloten | Megaforge | Mr forge | Necfo | Necpo | Neoforge | New dqforce | Newcoforge | Newdqforce | Newgenforge | Norvasc v | Novaltan | Novasartan | Np forge | Onoforge | Orosartan | Rexfage q | S sartan | Sardipine | Staforge | Stafozy | Synect | Tds sartan | Twotwoforge | Unasartan | Uniforge | Uroforge | V dipine | Valadipine | Valdipine | Valsadipine | Valsaforce | Valsapine | Valsar m | Valsarex | Valsarodin | Valtan x | Vardipine | Varoforge | Vasalpine | Vdipine | Vforge | Visforge | Wenex g | Winexge | Withforg | Withforge | Worldforge | X detension | X lotan | Xdetension | Xlow | Xpera | Yuyuforge;
  • (KW) Kuwait: Exforge | Lotevan;
  • (LB) Lebanon: Angiosar | Exforge | Lotevan | Povam | Simultan a | Viostan am;
  • (LT) Lithuania: Amlodipine/valsartan | Amlodipine/valsartan inteli | Amlodipine/valsartan teva | Dipperam | Exforge | Valsartan/amlodipine teva pharma | Wamlox;
  • (LU) Luxembourg: Amlodipine/valsartan EG | Exforge;
  • (LV) Latvia: Amlodipine/valsartan teva | Dipperam | Exforge | Wamlox;
  • (MA) Morocco: Exforge | Lotevan | Suliat;
  • (MX) Mexico: Exforge | Jadavan;
  • (MY) Malaysia: Amval | Exforge;
  • (NG) Nigeria: Amlosartan | Avsar | Carvals am | Dioplus | Exforge | Lastavin am | Nordexa plus | Odizat | Poccosart | Potenza | Senergy | Valsar am | Valsartan and amlodipine;
  • (NL) Netherlands: Amlodipine and valsartan | Amlodipine/valsartan | Amlodipine/valsartan aurobindo | Amlodipine/valsartan teva | Copalia | Exforge;
  • (NO) Norway: Bevacomb | Exforge;
  • (PE) Peru: Exforge | Valsiprel a;
  • (PH) Philippines: Amloval | Hybip | Trivan plus | Valazyd AM | Valcamp | Valianz | Valnorm duo | Valsadex | Valsar plus | Valsaram | Valtam | Valvex a;
  • (PK) Pakistan: A v | Address | Alvan | Alvostan | Alvostan ds | Am salvan | Amdosart plus | Amlodine | Amloplus | Amlortan | Amloval | Amlovastan | Amlove | Amlowell | Amodip-v | Amsart | Amsartan | Amstan | Amval | Amvart | Amvart ds | Av sartan | Avaam | Avsar | Biforge | Caloc v | Co redupres | Co valzaar | Co velker | Covam | Covance | Di valsar | Dioplus | Diovasc | Dipval | Dipval plus | Distan | Emhart | Exotan | Extor | Exval a | Listan am | Newday | Onato v | Plonim | Valam | Valcard | Valday | Valdipine | Valken a | Valmax am | Valmo | Valpin | Valsar m | Valsarpin | Valta am | Valtan m | Valtec am | Valturna a | Velvet am | Walpine | Zeglopin v;
  • (PL) Poland: Avasart plus | Dipperam | Exforge | Wamlox;
  • (PR) Puerto Rico: Amlodipine and valsartan | Amlodipine besylate and valsartan | Exforge;
  • (PT) Portugal: Amlodipina + Valsartan Ciclum | Amlodipina + valsartan Mylan | Amlodipina + valsartan pentafarma | Amlodipina + valsartan ratiopharm | Amlodipina + Valsartan Teva | Amlodipine+ Valsartan Aurovitas | Copalia | Dafiro;
  • (PY) Paraguay: Valaxam;
  • (QA) Qatar: Angiosar | Exforge | Newstar | Senergy;
  • (RO) Romania: Amlodipina/valsartan aurobindo | Amlodipina/valsartan stada | Amlodipina/valsartan zentiva | Dipperam | Exforge;
  • (RU) Russian Federation: Amlodipine valsartan richter | Amlodipine-valsartan | Amlodipine/valsartan Richter | Artinova am | Disartan | Exforge | Exfotanz | Narunel | Valz combi | Vamloset;
  • (SA) Saudi Arabia: Amlor plus | Amstar | Senergy | Vittoria;
  • (SE) Sweden: Amlodipin/valsartan 2care4 | Amlodipin/valsartan ebb | Amlodipin/valsartan krka | Amlodipin/valsartan stada | Exforge;
  • (SG) Singapore: Exforge;
  • (SI) Slovenia: Wamlox;
  • (SK) Slovakia: Amlodipin/valsartan sandoz | Wamlox;
  • (SR) Suriname: Exforge;
  • (TH) Thailand: Dafiro;
  • (TN) Tunisia: Amlosartan zentiva | Amlovar | Duofor | Exforge | Icatens | Neaforge | Tensiovals duo | Value plus;
  • (TR) Turkey: Cardofix | Combisar | Valcodin | Valtan a;
  • (TW) Taiwan: Am daianxo | Am-daiwen | Amoten | Amvlo | Asartan | Dafiro | Estengy | Exfopine | Exforge | Exnortan | Valsoon;
  • (UA) Ukraine: Adeniz am | Amlosartan | Corsar am | Difors | Difors 160 | Difors 80 | Difors xl | Exforge | Kombisart | Valembik | Valmisar a | Valodip | Vasar A;
  • (UG) Uganda: Amva denk | Exforge | Newstar | Senergy | Valmaca | Valsar am;
  • (UY) Uruguay: Exforge | Simultan a | Tensofin vl;
  • (VE) Venezuela, Bolivarian Republic of: Exforge | Vasanor;
  • (ZA) South Africa: Arlozyb | Calsar | Copalia | Dafiro | Exforge | Forgevasc | Gemvalaz | Tensoforj | Valduo | Valvasc;
  • (ZM) Zambia: Exforge;
  • (ZW) Zimbabwe: Exforge | Starval am
  1. Exforge (amlodipine/valsartan) [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; April 2021.
  2. Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(2):1014-1048. doi:10.1002/hep.31884 [PubMed 33942342]
  3. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124(23):2610-2642. [PubMed 22064600]
  4. Jorgensen MG. Prevalence of Amlodipine-Related Gingival Hyperplasia. J Periodontol. 1997;68(7):676-678. [PubMed 9249639]
  5. Naito T, Kubono N, Deguchi S, et al. Amlodipine passage into breast milk in lactating women with pregnancy-induced hypertension and its estimation of infant risk for breastfeeding. J Hum Lact. 2015;31(2):301-306. [PubMed 25447596]
  6. Poldermans D, Glazer R, Karagiannis S, et al. Tolerability and blood pressure-lowering efficacy of the combination of amlodipine plus valsartan compared with lisinopril plus hydrochlorothiazide in adult patients with stage 2 hypertension. Clin Ther. 2007;29(2):279-289. doi:10.1016/j.clinthera.2007.02.003 [PubMed 17472820]
  7. Runyon BA; AASLD. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013;57(4):1651-1653. doi:10.1002/hep.26359 [PubMed 23463403]
  8. Sipahi I, Debanne SM, Rowland DY, et al. Angiotensin-Receptor Blockade and Risk of Cancer: Meta-Analysis of Randomised Controlled Trials. Lancet Oncol. 2010;11(7):627-636. [PubMed 20542468]
  9. Wynn RL. Calcium Channel Blockers and Gingival Hyperplasia-An Update. Gen Dent. 2009;57(2):105-107. [PubMed 19552357]
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