|
|
| Line 1: |
Line 1: |
| __NOTOC__
| | #REDIRECT [[Valsartan#Drug Interactions]] |
| {{Valsartan}}
| |
| {{CMG}}; {{AE}} {{SS}}
| |
| | |
| ==Drug Interactions==
| |
| | |
| No clinically significant pharmacokinetic interactions were observed when Diovan (valsartan) was coadministered with [[amlodipine]], [[atenolol]], [[cimetidine]], [[digoxin]], [[furosemide]], [[glyburide]], [[hydrochlorothiazide]], or [[indomethacin]]. The valsartan-atenolol combination was more antihypertensive than either component, but it did not lower the heart rate more than [[atenolol]] alone.
| |
| | |
| Coadministration of valsartan and [[warfarin]] did not change the pharmacokinetics of valsartan or the time-course of the anticoagulant properties of [[warfarin]].
| |
| | |
| '''CYP 450 Interactions''': In vitro metabolism studies indicate that CYP 450 mediated drug interactions between valsartan and coadministered drugs are unlikely because of the low extent of metabolism [see Clinical Pharmacology (12.3)].
| |
| | |
| '''Transporters''': The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1 and the hepatic efflux transporter MRP2. Coadministration of inhibitors of the uptake transporter ([[rifampin]],[cyclosporine]]) or efflux transporter ([[ritonavir]]) may increase the systemic exposure to valsartan.
| |
| | |
| '''Potassium''': Concomitant use of valsartan with other agents that block the [[renin-angiotensin system]], potassium sparing [[diuretics]](e.g. [[spironolactone]], [[triamterene]], [[amiloride]]), potassium supplements, or salt substitutes containing potassium may lead to increases in serum potassium and in [[heart failure]] patients to increases in serum creatinine. If co-medication is considered necessary, monitoring of serum potassium is advisable.
| |
| | |
| Non-Steroidal Anti-Inflammatory Agents including Selective Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors): In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of [[NSAIDs]], including selective COX-2 inhibitors, with angiotensin II receptor antagonists, including valsartan, may result in deterioration of renal function, including possible [[acute renal failure]]. These effects are usually reversible. Monitor renal function periodically in patients receiving valsartan and [[NSAID]] therapy.
| |
| | |
| The antihypertensive effect of angiotensin II receptor antagonists, including valsartan may be attenuated by NSAIDs including selective COX-2 inhibitors.
| |
| | |
| Dual Blockade of the [[renin-angiotensin system]] (RAS): Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or [[aliskiren]] is associated with increased risks of [[hypotension]], [[hyperkalemia]], and changes in renal function (including [[acute renal failure]]) compared to monotherapy. Closely monitor blood pressure, renal function and electrolytes in patients on Diovan and other agents that affect the RAS.
| |
| | |
| Do not coadminister [[aliskiren]] with Diovan in patients with diabetes. Avoid use of aliskiren with Diovan in patients with renal impairment (GFR <60 mL/min).
| |
| | |
| ===7.1 Clinical Laboratory Test Findings===
| |
| | |
| In controlled clinical trials, clinically important changes in standard laboratory parameters were rarely associated with administration of Diovan.
| |
| | |
| '''Creatinine''': Minor elevations in creatinine occurred in 0.8% of patients taking Diovan and 0.6% given placebo in controlled clinical trials of hypertensive patients. In [[heart failure]] trials, greater than 50% increases in creatinine were observed in 3.9% of Diovan-treated patients compared to 0.9% of placebo-treated patients. In post-[[myocardial infarction]] patients, doubling of serum creatinine was observed in 4.2% of valsartan-treated patients and 3.4% of captopril-treated patients.
| |
| | |
| '''Hemoglobin and Hematocrit''': Greater than 20% decreases in hemoglobin and hematocrit were observed in 0.4% and 0.8%, respectively, of Diovan patients, compared with 0.1% and 0.1% in placebo-treated patients. One valsartan patient discontinued treatment for microcytic anemia.
| |
| | |
| '''Liver Function Tests''': Occasional elevations (greater than 150%) of liver chemistries occurred in Diovan-treated patients. Three patients (< 0.1%) treated with valsartan discontinued treatment for elevated liver chemistries.
| |
| | |
| '''Neutropenia''': Neutropenia was observed in 1.9% of patients treated with Diovan and 0.8% of patients treated with placebo.
| |
| | |
| '''Serum Potassium''': In hypertensive patients, greater than 20% increases in serum potassium were observed in 4.4% of Diovan-treated patients compared to 2.9% of placebo-treated patients. In heart failure patients, greater than 20% increases in serum potassium were observed in 10.0% of Diovan-treated patients compared to 5.1% of placebo-treated patients.
| |
| | |
| '''Blood Urea Nitrogen (BUN)''': In heart failure trials, greater than 50% increases in BUN were observed in 16.6% of Diovan-treated patients compared to 6.3% of placebo-treated patients.<ref name="dailymed.nlm.nih.gov">{{Citace elektronické monografie | příjmení = | jméno = | titul = DIOVAN (VALSARTAN) TABLET [NOVARTIS PHARMACEUTICALS CORPORATION] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=5ddba454-f3e6-43c2-a7a6-58365d297213 | vydavatel = | datum vydání = | datum aktualizace = | datum přístupu = 2014-02-24 }}</ref>
| |
| | |
| ==References==
| |
| {{reflist|2}}
| |
| | |
| {{Angiotensin II receptor antagonists}}
| |
| | |
| [[Category:Amides]]
| |
| [[Category:Angiotensin II receptor antagonists]]
| |
| [[Category:Biphenyls]]
| |
| [[Category:Carboxylic acids]]
| |
| [[Category:Novartis]]
| |
| [[Category:Tetrazoles]]
| |
| [[Category:Cardiovascular Drugs]]
| |
| [[Category:Drugs]]
| |