Diovan (valsartan) is an angiotensin II receptor blocker (ARB) prescribed for the management of hypertension (high blood pressure) and heart failure, as well as to improve survival following a myocardial infarction in clinically stable patients with left ventricular failure or dysfunction. It works by blocking the action of certain natural substances that tighten the blood vessels, allowing blood to flow more smoothly and the heart to pump more efficiently. This medication is widely recognized in clinical practice for its efficacy, tolerability, and cardiovascular protective benefits, making it a cornerstone therapy in modern antihypertensive treatment regimens.

Features

• Contains the active ingredient valsartan, a selective angiotensin II type 1 (AT1) receptor antagonist
• Available in tablet form in multiple strengths: 40 mg, 80 mg, 160 mg, and 320 mg
• Administered orally, typically once or twice daily depending on indication
• Exhibits high specificity for the AT1 receptor, with no agonist activity
• Demonstrates linear pharmacokinetics with dose proportionality
• Not a prodrug; active molecule does not require hepatic conversion
• Exhibits approximately 95% plasma protein binding
• Primarily eliminated via biliary excretion

Benefits

• Effectively lowers blood pressure, reducing the risk of strokes, heart attacks, and kidney problems
• Provides 24-hour blood pressure control with once-daily dosing in many patients
• Demonstrates excellent tolerability profile with low incidence of side effects such as cough compared to ACE inhibitors
• Shows proven cardiovascular outcomes benefits in high-risk hypertensive patients
• Offers renal protective effects in patients with type 2 diabetes and nephropathy
• May be used as monotherapy or in combination with other antihypertensive agents

Common use

Diovan is primarily indicated for the treatment of hypertension in adults and children 6 years and older. It may be used alone or in combination with other antihypertensive agents. Additionally, it is indicated for heart failure (NYHA Class II-IV) in patients who are intolerant of ACE inhibitors, and for the reduction of cardiovascular mortality in clinically stable patients with left ventricular failure or dysfunction following acute myocardial infarction. In diabetic nephropathy, Diovan has demonstrated renal protective effects in patients with type 2 diabetes and hypertension.

Dosage and direction

The recommended starting dose for hypertension in adults is 80 mg or 160 mg once daily, with a maximum dose of 320 mg daily. The dosage may be divided for twice-daily administration if needed for better blood pressure control. For heart failure, the recommended starting dose is 40 mg twice daily, which may be titrated to 80 mg and then 160 mg twice daily as tolerated. For post-myocardial infarction management, therapy may be initiated as early as 12 hours after infarction, starting with 20 mg twice daily and titrated to 40 mg, 80 mg, and 160 mg twice daily as tolerated. Pediatric dosing for hypertension (6-16 years) is based on body weight. Tablets should be taken with or without food, at approximately the same time each day.

Precautions

Patients should be monitored for hypotension, especially volume-depleted patients or those on diuretic therapy. Renal function should be assessed prior to initiation and periodically during treatment, particularly in patients with renal impairment, heart failure, or those receiving NSAIDs. Serum potassium should be monitored regularly, especially in patients with impaired renal function, diabetes, or those taking potassium-sparing diuretics or potassium supplements. Use with caution in patients with hepatic impairment, as valsartan exposure increases with severity of hepatic dysfunction. Not recommended during pregnancy due to potential fetal harm. Elderly patients may have increased sensitivity to the hypotensive effects.

Contraindications

Diovan is contraindicated in patients with known hypersensitivity to any component of the formulation. Concomitant use with aliskiren in patients with diabetes is contraindicated. Should not be used during pregnancy, as drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus. Avoid use in patients with severe hepatic impairment, biliary cirrhosis, or biliary obstruction. Not recommended in patients with severe renal impairment or end-stage renal disease requiring dialysis.

Possible side effect

Common adverse reactions (≥2% and greater than placebo) include dizziness, hypotension, hyperkalemia, and elevated blood creatinine. Less common side effects may include headache, fatigue, abdominal pain, nausea, diarrhea, viral infection, anemia, arthralgia, and back pain. Rare but serious adverse effects include angioedema, renal impairment, hepatotoxicity, and neutropenia. Postmarketing reports include cases of rhabdomyolysis, tinnitus, and photosensitivity reactions. Most side effects are mild to moderate in severity and often diminish with continued therapy.

Drug interaction

Concomitant use with potassium-sparing diuretics, potassium supplements, or salt substitutes containing potassium may lead to hyperkalemia. NSAIDs, including selective COX-2 inhibitors, may reduce the antihypertensive effect and increase the risk of renal impairment. Dual blockade of the renin-angiotensin system with ACE inhibitors, aliskiren, or other ARBs increases risks of hypotension, hyperkalemia, and renal impairment. Lithium levels may increase when coadministered with Diovan. Rifampin may decrease valsartan concentrations. No significant interactions have been observed with warfarin, digoxin, atenolol, furosemide, glibenclamide, or hydrochlorothiazide.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed dose. Consistency in dosing is important for maintaining stable blood pressure control, so patients should be advised to establish a routine for medication administration.

Overdose

The most likely manifestation of overdose would be hypotension and tachycardia. Bradycardia could occur from parasympathetic (vagal) stimulation. If overdose occurs, the patient should be placed in a supine position and given supportive treatment, including volume expansion with intravenous normal saline. Valsartan is not removed by hemodialysis. Symptomatic and supportive measures should be instituted based on the clinical presentation. Close monitoring of vital signs, electrolyte balance, and renal function is essential in cases of suspected overdose.

Storage

Store Diovan tablets at room temperature between 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C to 30°C (59°F to 86°F). Keep in the original container with the lid tightly closed to protect from moisture and light. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Do not store in bathroom cabinets where moisture levels may be higher. Properly discard any unused medication that is outdated or no longer needed.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting, stopping, or changing any medication regimen. Individual patient responses to medication may vary, and treatment decisions should be based on the healthcare provider’s assessment of the specific clinical situation. The prescribing information provided here may not include all possible uses, directions, precautions, or interactions.

Reviews

Clinical studies have demonstrated Diovan’s efficacy in blood pressure reduction with pooled data showing mean reductions of 8-12 mmHg in systolic and 5-8 mmHg in diastolic blood pressure at 80-160 mg daily doses. The VALHEFT trial showed significant reduction in mortality and morbidity in heart failure patients when added to standard therapy. The VALIANT trial demonstrated non-inferiority to captopril in post-myocardial infarction patients with heart failure. In diabetic nephropathy, Diovan has shown superior renal protective effects compared to amlodipine. Patient satisfaction surveys indicate high tolerability and preference due to minimal side effects compared to other antihypertensive classes.