Valz
Hyperkalemia
When used simultaneously with dietary supplements containing potassium, potassium-sparing diuretics, potassium-containing salt substitutes, or with other drugs that may cause an increase in potassium levels in the blood (for example, heparin), caution should be exercised and regular monitoring of potassium levels in the blood should be carried out.
Renal dysfunction
There is no experience of safe use in patients with creatinine clearance less than 10 ml/min and in patients on hemodialysis, so valsartan should be used with caution in such patients. In patients with CC more than 10 ml/min, no dose adjustment is required.
Liver dysfunction
In patients with mild or moderate hepatic impairment without cholestasis, valsartan should be used with caution.
Sodium deficiency in the body and/or decreased blood volume
In patients with severe sodium deficiency in the body and/or reduced blood volume, for example, those receiving high doses of diuretics, in rare cases, after starting therapy with valsartan, arterial hypotension may develop, accompanied by clinical manifestations.
Before starting treatment with Valz, it is necessary to adjust the sodium content in the body and/or replenish the blood volume, including by reducing the dose of the diuretic.
Renal artery stenosis
The use of the drug in a short course in patients with renovascular hypertension, which developed secondary to unilateral stenosis of the artery of a single kidney, does not lead to any significant change in renal hemodynamics, serum creatinine concentration or blood urea nitrogen.
However, given that other drugs that affect the RAAS may cause an increase in serum urea and creatinine concentrations in patients with bilateral renal artery stenosis or stenosis of the artery of a solitary kidney, monitoring these indicators is recommended as a precautionary measure.
Kidney transplant
There are no data on the safety of using Valz in patients who have undergone kidney transplantation.
Primary hyperaldosteronism
The drug is not effective for the treatment of arterial hypertension in patients with primary hyperaldosteronism, since activation of the RAAS is not observed in this category of patients.
Aortic and mitral stenosis, obstructive hypertrophic cardiomyopathy
As with other vasodilating agents, caution should be exercised when taking Valz in patients with aortic or mitral stenosis and obstructive hypertrophic cardiomyopathy.
Pregnancy
Taking angiotensin II receptor antagonists is contraindicated during pregnancy. Patients planning a pregnancy should choose treatment with alternative medications that have a proven safety profile when used during pregnancy.
If pregnancy is diagnosed during treatment with Valz, it should be discontinued as soon as possible and alternative treatment prescribed (see sections “Contraindications” and “Use during pregnancy and breastfeeding”).
CHF/period after myocardial infarction
In patients with CHF or after myocardial infarction who begin treatment with valsartan, a slight decrease in blood pressure is often observed, and therefore it is recommended to monitor blood pressure at the beginning of therapy. If you follow the recommendations for changing the dosage regimen, there is usually no need to discontinue the drug due to arterial hypotension. Evaluation of patients with CHF should include assessment of renal function.
Due to inhibition of the RAAS, renal dysfunction may occur in some patients. In patients with CHF functional class II-IV according to the NYHA classification, treatment with ACE inhibitors and angiotensin II receptor antagonists may be accompanied by oliguria and/or an increase in azotemia and, in rare cases, the development of acute renal failure and/or death. Therefore, in these categories of patients, before using the drug Valz, as well as periodically during treatment, it is necessary to assess renal function.
Combination therapy for arterial hypertension
For arterial hypertension, the drug Valz can be used in monotherapy, as well as in combination with other antihypertensive drugs, in particular with diuretics.
Combination therapy in the period after myocardial infarction
It is possible to use the drug Valz in combination with other drugs used after myocardial infarction, namely: thrombolytics, acetylsalicylic acid as an antiplatelet agent, beta-blockers, HMG-CoA reductase inhibitors and diuretics. In this category of patients, it is not recommended to use Valz simultaneously with ACE inhibitors, since this combination therapy does not have advantages over valsartan or ACE inhibitor monotherapy in terms of overall mortality from any cause.
Combination therapy for CHF
For CHF, the drug Valz can be used both in monotherapy and simultaneously with other drugs - diuretics, cardiac glycosides, as well as ACE inhibitors or beta-blockers.
In this category of patients, the use of triple combination therapy with an ACE inhibitor, a beta-blocker and the drug Valz is not recommended.
Angioedema (Quincke's edema)
During treatment with valsartan, there have been reports of the development of angioedema, accompanied by swelling of the larynx and vocal cords, leading to airway obstruction, and/or swelling of the face, lips, pharynx and/or tongue. Some patients in this group had previously experienced angioedema while taking other medications, including ACE inhibitors.
If angioedema develops, Valz should be discontinued immediately, after which drugs containing valsartan should not be taken in the future.
Double blockade of the RAAS
When treated with drugs that affect the RAAS, especially when they were combined, a marked decrease in blood pressure, syncope, stroke, hyperkalemia and changes in renal function (including acute renal failure) have been reported in sensitive patients.
Caution is required when combining angiotensin II receptor antagonists, including valsartan, with other drugs that block the RAAS, such as ACE inhibitors or aliskiren.
Concomitant use of angiotensin II receptor antagonists, including valsartan, with drugs containing aliskiren is contraindicated in patients with diabetes mellitus and/or with moderate or severe renal impairment (GFR less than 60 ml/min/1.73 m body surface area) and is not recommended in other patients. Concomitant use of angiotensin II receptor antagonists with ACE inhibitors is contraindicated in patients with diabetic nephropathy and is not recommended in other patients.
Other RAAS stimulation conditions (320 mg dose only)
In patients in whom renal function may be dependent on the activity of the RAAS (for example, patients with severe congenital heart failure), treatment with ACE inhibitors is associated with the occurrence of oliguria and/or progressive azotemia and, in rare cases, acute renal failure and/or death. Since valsartan is an angiotensin II receptor antagonist, it cannot be excluded that its use may be associated with impaired renal function.
Children and teenagers under 18 years of age
Renal dysfunction
The use of the drug has not been studied in patients aged 6 to 18 years with impaired renal function with creatinine clearance <30 ml/min, as well as in patients on hemodialysis, so its use in this group of patients is not recommended.
In patients from 6 to 18 years old with CC more than 30 ml/min, no dose adjustment is required. While taking Valz, renal function and serum potassium levels should be carefully monitored. In particular, these precautions must be observed when taking the drug Valz against a background of elevated temperature or decreased blood volume, since in this case the development of renal dysfunction is possible.
Liver dysfunction
As for adult patients, the use of Valz is contraindicated for patients from 6 to 18 years of age with severe liver dysfunction, biliary cirrhosis and cholestasis. Experience with the use of valsartan in patients with mild to moderate liver dysfunction is limited. The dose should not exceed 80 mg in this group of patients.
VALZ (tablets)
They started using sartans not very long ago, but this group has already proven itself well.
And if previously the drug of choice for the treatment of hypertension was ACE inhibitors (for example, “Perineva” - a modern drug with the active ingredient perindopril), now sartans are at the same level. In my humble opinion, the effectiveness of these groups is approximately the same, and if I do not prescribe sartan immediately, I will definitely replace the ACE inhibitor with sartan in case of a side effect - a dry cough. Here sartan benefits from the fact that it has no such side effects. In addition to hypertension, there are indications - heart failure (that is, it improves the activity of the heart) and nephropathy - kidney damage (it is believed that sartan protects almost and reduces the excretion of protein in the urine). Of all the sartans, the one I most often prescribe is valsartan, and the drug that is considered to be of the highest quality and has proven itself is “VALZ” (valsartan). But when there is a need for combination therapy, provided that the hypertension is grade 1-2, or the patient has edema, I take Valz N. In addition to the beneficial properties listed above, it also has a diuretic effect, which allows you to better control blood pressure and gradually relieve swelling. This is due to the content of hydrochlorothiazide in the composition. HCTZ (hydrochlorothiazide) is a representative of the thiazide diuretics. It acts slowly over 12-36 hours, which means that you won’t immediately run to the toilet to get rid of excess fluid, it will leave the body unnoticed. I also dare to note that HCTZ reduces the excretion of calcium in the urine and does not disturb the acid-base balance.
The indications are clear, the instructions describe them very sparingly, but I expanded their range a little. What about contraindications? Hypersensitivity, impaired liver and kidney function, SLE, children, pregnancy and lactation. I would also add severe diabetes mellitus here - specifically for the combination drug Valz N. But in principle, this is all rare, and your doctor will certainly take into account your characteristics.
Valz N should be taken once a day, in the morning. It is recommended to start with a small dosage (80+12.5), and then increase if necessary. But I often prescribe more at once, in principle at the discretion of the doctor, this is possible and not dangerous. Sometimes we have to prescribe Valz N for a month, and then switch to plain Valz, as the swelling subsides and blood pressure levels out, allowing us to reduce the dosage - but such therapy is not suitable for everyone. In general, there are a lot of options on how and what to take. The main thing to remember is that if you have hypertension, you must take an antihypertensive drug daily and constantly, regardless of your blood pressure numbers.
Packages of Valz N come in 28 tablets and 98 tablets - economical packaging. The cost is average, for example, my package with a dosage of 160+12.5 costs 375 rubles, and if you buy a pack for three months, it will cost me 952 rubles (which means it will cost 317 rubles for a month). Dosage 80+12.5 costs at the Maxavit pharmacy = 312 rubles - 28 tablets. In general, the prices are not cheap, of course, but 100% effect and excellent quality cannot cost 5 rubles.
Valz N maintains blood pressure well and relieves swelling, but only on condition that this drug is suitable for you. If you are an experienced hypertensive patient and your systolic blood pressure exceeds 200, then it is better to take another combination drug that includes amlodipine (calcium channel blocker), for example, the drug “LORTENZA” (losartan + amlodipine), but of course only as prescribed by your doctor doctor As for side effects, over several years of operation, Valz N only experienced dizziness a couple of times and had to be replaced. In general, the drug is excellent, the main thing is that it is prescribed correctly and in the right place. I recommend!
Valz instructions for use
In patients with severe sodium deficiency in the body and/or reduced blood volume, for example, due to taking large doses of diuretics, in rare cases, severe arterial hypotension may develop at the beginning of valsartan therapy. Before starting therapy with Valz, it is recommended to restore the electrolyte and fluid levels in the body, in particular by reducing the doses of diuretics. The effect of Valz is enhanced when combined with diuretics. The drug Valz can be used in conjunction with other drugs intended for the treatment of myocardial infarction, such as thrombolytics, acetylsalicylic acid, beta-blockers, statins and diuretics. Concomitant use of ACE inhibitors is not recommended.
In case of renovascular hypertension, regular monitoring of urea and creatinine levels in the blood is necessary. When used together with drugs containing potassium, its salts and drugs belonging to the group of potassium-sparing diuretics, regularly monitor the level of potassium in the blood plasma. In patients with CHF who begin treatment with Valz, a slight decrease in blood pressure may be observed, and therefore it is recommended to monitor blood pressure at the beginning of therapy. Due to inhibition of the renin-angiotensin-aldosterone system, changes in renal function may occur in some patients. In patients with severe CHF, in whom renal function depends on the activity of the renin-angiotensin-aldosterone system, treatment with ACE inhibitors and angiotensin receptor antagonists may be accompanied by oliguria and/or increased azotemia and (rarely) acute renal failure and/or death.
The combined use of the drug Valz in patients suffering from CHF with ACE inhibitors and beta-blockers is not recommended due to a possible increased risk of side effects. In patients with bilateral or unilateral renal artery stenosis, regular monitoring of serum creatinine and urea nitrogen levels is necessary.
Impact on the ability to drive a car and perform work requiring increased attention
During the treatment period, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of motor and mental reactions.
Valz tab 160mg N98 (Actavis)
In patients with severe sodium deficiency in the body and/or reduced blood volume, for example, due to taking diuretics in high doses, in rare cases, severe arterial hypotension may develop at the beginning of valsartan therapy. Before starting therapy with Valz, it is recommended to restore the electrolyte and fluid levels in the body, in particular by reducing the doses of diuretics. The drug Valz can be used in conjunction with other drugs intended for the treatment of myocardial infarction, such as thrombolytics, acetylsalicylic acid, beta-blockers, statins and diuretics. Concomitant use of ACE inhibitors is not recommended. In case of renovascular hypertension, regular monitoring of urea and creatinine levels in the blood is necessary. When used together with drugs containing potassium, its salts and drugs belonging to the group of potassium-sparing diuretics, regularly monitor the level of potassium in the blood plasma. In chronic heart failure, at the beginning of treatment with Valz, a slight decrease in blood pressure may be observed, so it is recommended to monitor blood pressure at the beginning of therapy. Due to inhibition of the renin-angiotensin-aldosterone system, changes in renal function may occur in some patients. In patients with severe chronic heart failure, in whom renal function depends on the activity of the renin-angiotensin-aldosterone system, treatment with ACE inhibitors and angiotensin receptor antagonists may be accompanied by oliguria and/or increased azotemia and (rarely) acute renal failure and/or death. The combined use of Valz in patients suffering from chronic heart failure with ACE inhibitors and beta-blockers is not recommended due to a possible increased risk of side effects. In patients with bilateral or unilateral renal artery stenosis, regular monitoring of serum creatinine and urea nitrogen levels is necessary. Effect on the ability to drive vehicles and operate machinery During the treatment period, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.
