Valsartan
Brand names: Diovan
Class: 💊 ACE Inhibitors & ARBs
What examiners watch for is recognition of valsartan as the ARB component of sacubitril-valsartan (Entresto) for HFrEF. As an angiotensin II receptor blocker, valsartan treats hypertension, post-MI with LV dysfunction, and heart failure — and when paired with the neprilysin inhibitor sacubitril, it forms the ARNI that has replaced enalapril as preferred first-line therapy in HFrEF. Wash out an ACE inhibitor for at least 36 hours before starting sacubitril-valsartan to avoid angioedema from overlapping bradykinin pathways. Like all RAAS blockers, valsartan is contraindicated in pregnancy, bilateral renal artery stenosis, and hyperkalemia. Side effects mirror losartan; cough is rare because the bradykinin pathway is bypassed.
✅ Indications
HTN, post-MI with LV dysfunction, CHF. Combined with sacubitril (Entresto) for HFrEF.
⚙️ Mechanism of Action
ARB.
📏 Dosing
80–320 mg PO daily.
🚫 Contraindications
Pregnancy, bilateral RAS, angioedema hx.
⚠️ Adverse Effects
HyperK, AKI, hypotension, dizziness.
🔬 Monitoring
BP, K⁺, creatinine.
💎 Board Pearls
- 💊 Sacubitril/valsartan (Entresto) = gold-standard HFrEF add-on; do NOT combine with ACE inhibitor (36-hour washout required).
Practice Questions
A 70-year-old man with HFrEF (LVEF 28%), NYHA class II symptoms, and estimated GFR 56 is currently on lisinopril (Zestril) 20 mg daily, carvedilol 25 mg BID, and spironolactone. Following cardiology recommendations, you plan to transition him from lisinopril to sacubitril/valsartan (Entresto) to improve mortality outcomes per PARADIGM-HF. Which of the following is the MOST appropriate plan for the transition?
Related Drugs in This Class
- Lisinopril — Prinivil, Zestril
- Ramipril — Altace
- Losartan — Cozaar
Sources
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