valsartan

(val sar' tan)
Diovan Pregnancy Category C (first trimester) Pregnancy Category D (second and third trimesters)
Drug classes

Angiotensin II receptor blocker (ARB) Antihypertensive
Therapeutic actions

Selectively blocks the binding of angiotensin II to specific tissue receptors found in the vascular smooth muscle and adrenal gland; this action blocks the vasoconstricting effect of the renin–angiotensin system as well as the release of aldosterone, leading to decreased BP; may prevent the vessel remodeling associated with the development of atherosclerosis.
Indications

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Treatment of hypertension, alone or in combination with other antihypertensives Treatment of heart failure in patients who are intolerant of angiotensin-converting enzyme (ACE) inhibitors Contraindicated with hypersensitivity to valsartan, pregnancy (use during second or third trimester can cause injury or even death to fetus), lactation. Use cautiously with hepatic or renal dysfunction, hypovolemia.

Contraindications and cautions

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Available forms

Tablets—40, 80, 160, 320 mg
Dosages ADULTS

80 mg PO daily; range 80–320 mg/day. • Heart failure: Starting dose is 40 mg bid, titration to 80 mg and 160 mg bid should be done to the highest dose, as tolerated by the patient. Maximum daily dose is 320 mg daily. Concomitant use with an ACE inhibitor and a beta blocker is not recommended.
PEDIATRIC PATIENTS

Safety and efficacy not established.
PATIENTS WITH HEPATIC OR RENAL IMPAIRMENT

Exercise caution and monitor patient frequently.
Pharmacokinetics
Route Oral Onset Varies Peak 2–4 hr

Metabolism: Hepatic; T1/2: 6 hr Distribution: Crosses placenta; passes into breast milk Excretion: Feces and urine
Adverse effects

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CNS: Headache, dizziness, syncope, muscle weakness CV: Hypotension Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin GI: Diarrhea, abdominal pain, nausea, constipation, dry mouth, dental pain Respiratory: URI symptoms, cough, sinus disorders Other: Cancer in preclinical studies, back pain, fever, gout

Nursing considerations Assessment

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History: Hypersensitivity to valsartan; pregnancy, lactation; hepatic or renal dysfunction; hypovolemia Physical: Skin lesions, turgor; T; reflexes, affect; BP; R, respiratory auscultation; liver and renal function tests Administer without regard to meals. Ensure that patient is not pregnant before beginning therapy; suggest using barrier birth control while using drug; fetal injury and deaths have been reported. Find alternative method of feeding infant if drug is being given to nursing mother. Depression of renin–angiotensin system in infants is potentially very dangerous. Alert surgeon and mark patient's chart that valsartan is being given. Blockage of renin–angiotensin system following surgery can produce problems. Hypotension may be reversed with volume expansion. Monitor patient closely in any situation that may lead to decrease in BP secondary to reduction in fluid volume—excessive perspiration, dehydration, vomiting, diarrhea—as excessive hypotension can occur. Take this drug without regard to meals. Do not stop taking drug without consulting your nurse or physican. Use a barrier method of birth control while using this drug; if you become pregnant or desire to become pregnant, consult your physician. These side effects may occur: Dizziness (avoid driving or performing hazardous tasks); headache (medications may be available to help); nausea, vomiting, diarrhea (proper nutrition is important; consult your dietitian); symptoms of upper respiratory tract infection, cough (do not self-medicate; consult your nurse or physician if this becomes uncomfortable). Report fever, chills, dizziness, pregnancy.

Interventions

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Teaching points

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Adverse effects in Italic are most common; those in Bold are life-threatening.

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