Valsartan/Hydrochlorothiazide

DEA Class; Rx

Common Brand Names; Diovan HCT

• ARB/HCTZ Combos

Angiotensin II blocker and thiazide diuretic once-daily product
Used for hypertension
Additive efficacy; less potassium loss than with hydrochlorothiazide alone.

Indicated for the treatment of hypertension.

Hypersensitivity to valsartan, hydrochlorothiazide, or sulfonamides

Anuria

Coadministration with aliskiren in patients with diabetes

Valsartan

• Hyperkalemia (4-10%)
• Dizziness (2-8%)
• Hypotension (1-7%)
• Fatigue (3%)

Hydrochlorothiazide

• Anaphylaxis
• Anemia
• Anorexia
• Confusion
• Dizziness
• Epigastric distress
• Erythema multiforme
• Exfoliative dermatitis, including toxic epidermal necrolysis
• Headache
• Hyperuricemia
• Hypokalemia or hypomagnesemia
• Orthostatic hypotension
• Photosensitivity
• Stevens-Johnson syndrome

Hypersensitivity reactions to hydrochlorothiazide may occur in patients with or without a history of allergy or bronchial asthma, but are more likely in patients with such a history

Thiazide diuretics have been reported to cause exacerbation or activation of systemic lupus erythematosus

Orthostatic hypotension risk: Initiate combination therapy with 2 antihypertensive drugs cautiously in patients with diabetes or autonomic dysfunction and in geriatric patients

Use with caution in severe hepatic impairment

With CrCl <30 mL/min use loop diuretic instead of hydrochlorothiazide

Dual blockade of the renin-angiotensin system with ARBs, angiotensin-converting enzyme (ACE) inhibitors, or aliskiren is associated with increased risk of hypotension, hyperkalemia, and altered renal function (including acute renal failure) in comparison with monotherapy

Phototoxicity may occur; instruct patients to protect skin from sun and undergo regular skin cancer screening

Angiotensin system during second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death

There is limited information regarding presence of drug in human milk, effects on breastfed infant, or on milk production; valsartan is present in rat milk; hydrochlorothiazide is present in human breast milk