Valsartan: analogues and substitutes for blood pressure, which is better

Valsartan is used to lower blood pressure in arterial hypertension (hypertension). The mechanism of action has been thoroughly studied, and its effectiveness has been proven in clinical studies.

To treat hypertension, both monotherapy and combinations with other substances are used. Most often, hydrochlorothiazide or Sacubitril are combined with Valsartan, which enhance the hypotensive effect.

Combination drugs are produced, for example, Co-Valsartan, Uperio.

pharmachologic effect

Manufacturer: Ozon LLC, Russia / JSC Vertex, Russia
Release form: film-coated tablets

Active ingredient: valsartan

Synonyms: Valsacor, Diovan

Valsartan is an angiotensin II receptor antagonist. Working at the receptor level, the drug reduces blood pressure.

The effect occurs within two hours after taking the tablet. After 4-6 hours, the maximum reduction in blood pressure is achieved. The persistent antihypertensive effect lasts 24 hours.

To achieve a stable effect, a course of 2 weeks is prescribed. Typically, patients with arterial hypertension take the drug in long courses.

If you abruptly stop taking the medication, withdrawal syndrome does not develop, which is an advantage of Valsartan over some analogues.

The drug is taken strictly as prescribed by a doctor and under his supervision. You can buy Valsartan or its analogues at a pharmacy only with a prescription.

Description of the drug VALSARTAN PLUS

Lithium preparations -

with simultaneous use of lithium preparations with ACE inhibitors and angiotensin II receptor blockers or thiazide diuretics, a reversible increase in the concentration of lithium in the blood plasma and an associated increase in toxic manifestations were noted. The risk of toxicities associated with the use of lithium may be further increased during concomitant use of this combination since the renal clearance of lithium is reduced by thiazide diuretics. Concomitant use of the combination of valsartan + hydrochlorothiazide is contraindicated.

Antihypertensive drugs -

it is possible to enhance the antihypertensive effect when used together with other drugs that lower blood pressure (ACE inhibitors, beta-blockers, slow calcium channel blockers, guanethidine, methyldopa, vasodilators, direct renin inhibitors, angiotensin II receptor blockers).

Pressor amines -

the effect of pressor amines (norepinephrine, epinephrine) may be weakened, without requiring cessation of joint use.

NSAIDs, including selective COX-2 inhibitors -

may weaken the antihypertensive effect of both angiotensin II receptor antagonists and hydrochlorothiazide when taken simultaneously. The simultaneous use of a combination of valsartan + hydrochlorothiazide and NSAIDs can lead to impaired renal function and an increase in potassium levels in the blood serum. If it is necessary to use this combination and NSAIDs together, renal function should be assessed and fluid and electrolyte disturbances corrected before starting treatment.

Potassium-containing substitutes for table salt; other medicines that increase serum potassium levels (for example, heparin)

requires compliance with precautions (including frequent determination of potassium levels in the blood).

Medicines that can cause hypokalemia -

The risk of hypokalemia caused by diuretics may be increased with simultaneous use of corticosteroids, laxatives, ACTH, amphotericin B, carbenoxolone, penicillin, acetylsalicylic acid or its derivatives and antiarrhythmic drugs.

Double blockade of the RAAS -

When treated with drugs that affect the RAAS, especially when they are combined, a marked decrease in blood pressure, syncope, stroke, hyperkalemia and impaired renal function (including acute renal failure) have been reported in sensitive patients. Concomitant use of the combination of valsartan + hydrochlorothiazide is contraindicated.

Caution is required when combining angiotensin II receptor blockers, including valsartan, with other drugs that block the RAAS, such as ACE inhibitors or aliskiren. Concomitant use of angiotensin II receptor blockers, including valsartan, or ACE inhibitors with aliskiren in patients with type 2 diabetes mellitus or impaired renal function (GFR < 60 ml/min/1.73 m2) is contraindicated.

Transport proteins -

According to the results of an in vitro study on hepatocyte cultures, valsartan is a substrate for the transporter proteins OATP1B1 and MRP2. Co-administration of valsartan with inhibitors of the OATP1B1 transport protein (rifampicin, cyclosporine) and with an inhibitor of the MRP2 transport protein (ritonavir) may increase the systemic exposure of valsartan (Cmax and AUC). Simultaneous use is contraindicated.

Curare-like muscle relaxants -

thiazide diuretics, including hydrochlorothiazide, potentiate the effect of non-depolarizing muscle relaxants. Simultaneous use is contraindicated.

Medicines that affect sodium levels in the blood -

The hyponatremic effect caused by diuretics may be enhanced when used simultaneously with antidepressants, antipsychotic anticonvulsants (carbamazepine). Caution should be exercised during long-term co-administration of hydrochlorothiazide with the above drugs.

Medicines that can provoke polymorphic ventricular
tachycardia of the "pirouette" type -
class IA antiarrhythmic drugs (quinidine, hydroquinidine, disopyramide); class III antiarrhythmic drugs (amiodarone, dofetilide, ibutilide), sotalol; some antipsychotics (thioridazine, chlorpromazine, levomepromazine, trifluoperazine, cyamemazine, sulpiride, sultopride, amisulpride, tiapride, pioside, haloperidol, droperidol); other drugs (bepridil, cisapride, difemanil, erythromycin IV, halofantrine, ketanserin, mizolastine, pentamidine, sparfloxacin, terfenadine, vincamine IV). Due to the risk of hypokalemia, hydrochlorothiazide should be used with caution concomitantly with drugs that can cause torsade de pointes (TdP).

Hypoglycemic agents -

Thiazide diuretics may alter glucose tolerance, which may require dose adjustments of insulin and oral hypoglycemic agents. Metformin should be used with caution due to the risk of developing lactic acidosis caused by possible renal impairment associated with hydrochlorothiazide.

Beta blockers and diazoxide -

simultaneous use of thiazide diuretics, incl. hydrochlorothiazide, with beta-blockers may increase the risk of developing hyperglycemia. Thiazide diuretics, incl. hydrochlorothiazide may enhance the hyperglycemic effect of diazoxide.

Anti-gout drugs (probenecid, sulfinpyrazone and allopurinol) -

Dosage adjustment of uricosuric agents (probenecid or sulfinpyrazone) may be required as hydrochlorothiazide may increase serum uric acid concentrations. Concomitant use of thiazide diuretics, including hydrochlorothiazide, may increase the incidence of hypersensitivity reactions to allopurinol.

Cardiac glycosides -

Hypokalemia and hypomagnesemia (undesirable effects of thiazide diuretics) may contribute to the development of cardiac arrhythmias in patients receiving cardiac glycosides.

N- and m-anticholinergics

(including atropine, biperiden) can increase the bioavailability of hydrochlorothiazide, which is associated with a decrease in gastrointestinal motility and the rate of gastric emptying. Accordingly, gastrointestinal motility stimulants (cisapride) may reduce the bioavailability of hydrochlorothiazide.

Cholestyramine and colestipol

may interfere with the absorption of concomitantly used drugs. The interval between doses should be 4-6 hours.

Vitamin D and calcium salts -

simultaneous use of hydrochlorothiazide with vitamin D or calcium supplements can lead to hypercalcemia due to increased calcium reabsorption.

Cyclosporine -

with simultaneous use of hydrochlorothiazide and cyclosporine, the risk of developing hyperuricemia and exacerbation of gout increases.

Methyldopa -

Cases of hemolytic anemia have been reported with the simultaneous administration of hydrochlorothiazide and methyldopa.

Co-administration of thiazide diuretics, including hydrochlorothiazide, may lead to an increased risk of side effects from amantadine

;
reducing the excretion by the kidneys of drugs that have a cytotoxic effect (for example, cyclophosphamide, methotrexate
), to potentiate their myelosuppressive effect.

Ethanol, barbiturates and narcotic drugs -

combined use with hydrochlorothiazide may potentiate the development of orthostatic hypotension.

When taking iodine contrast agents

in high doses against the background of a reduced volume of blood volume due to the use of diuretics, there is an increased risk of developing acute renal failure.

Indications for use of Valsartan

Indications for patients over 18 years of age:

• Arterial hypertension (hypertension).
• Chronic heart failure (in combination with other drugs).
• Post-acute myocardial infarction.

Patients who have suffered an acute myocardial infarction should take the drug in courses for up to two years, starting from 12 hours to 10 days after the onset of the infarction. In such cases, the risk of exacerbation of heart failure, recurrent heart attack and stroke is reduced.

Valsartan is also prescribed to children from 6 years of age for the treatment of arterial hypertension.

Valsartan - instructions for use

Valsartan is available in tablets of 40, 80, 160 mg of active ingredient. For arterial hypertension, the drug is taken once a day. As a rule, the doctor prescribes an initial dose of 80 mg for adults, then it is possible to increase the daily dose, as well as include other drugs in the treatment regimen.

For children, the dosage is calculated based on body weight.

For heart failure, treatment begins with 40 mg twice a day, then the dose is gradually increased.

After a myocardial infarction, a dosage regimen with increasing dosage is prescribed. Treatment is selected individually based on the patient’s indicators.

The tablets are taken orally, without chewing, with a sufficient amount of water.

Absorption of the active substance occurs regardless of food intake, so it does not matter to take Valsartan before or after meals.

Patient reviews

• Raisa, 53 years old. I have been suffering from hypertension for a long time. And periodically, addiction to all medications occurs, which is why they have to be changed. I’ve been using Valsartan for six months now, my blood pressure remains between one hundred and thirty to one hundred and forty, I feel good, and there are practically no headaches.
• Lyudmila, 47 years old. Due to the fact that the disease (stage 3 hypertension) began to gradually progress, the attending physician said that it was necessary to intensify therapy, and Valsartan alone was no longer enough. She prescribed me Valz N because it contains two drugs at once. The transition went smoothly, I felt better on Valse and my blood pressure stopped jumping.

Analogues of Valsartan

Analogues of the drug Valsartan are drugs that lower blood pressure in arterial hypertension. They differ in active ingredients, mechanism of action, dosage regimen, manufacturers, and price. On the Russian market there are equivalent substitutes for Valsartan, that is, synonyms:

• Valsacor;
• Diovan.

Independent replacement can only be made with synonyms. If a patient has a question about how to replace Valsartan for hypertension, it is necessary to consult a doctor.

For clarity, a comparison is made among Valsartan analogues in Russia in the initial daily dosage. One package is designed for an average month of treatment. There are imported and Russian substitutes on the market.

Enalapril

Manufacturer: JSC Obolenskoye, Russia;
Salutas Pharma, Germany Release form: tablets

Active ingredient: enalapril

Synonyms: Enap, Enam, Renitek

Analogs: Lisinopril, Perindopril, Captopril, Prestarium

Enalapril is a vasodilator and antihypertensive drug. Indicated to reduce blood pressure in patients with diabetes and chronic kidney disease.

This analogue lowers blood pressure, but side effects often occur. At the beginning of therapy, dizziness is possible, so caution is required when driving. Another common side effect of ACE inhibitors is a dry cough. In addition, the instructions for use include an extensive list of drugs incompatible with Enalapril.

Enalapril, both Russian and imported, is the most affordable anti-pressure medicine. If the price of analogues is a fundamental criterion when replacing Valsartan, Enalapril will be suitable.

Amlodipine

Manufacturer: Kanonpharma, Russia
Release form: tablets

Active ingredient: amlodipine

Synonyms: Norvask, Amlotop

This analogue is indicated for hypertension and angina pectoris. Amlodipine reduces blood pressure due to its relaxing effect on blood vessels. The active substance is absorbed gradually, which contributes to a smooth decrease in pressure and the absence of sudden changes. Can be used in patients with gout, diabetes and bronchial asthma.

Prescribe 5 mg of Amlodipine per day, usually no dose increase is required. In some cases, the dosage reaches 10 mg. In terms of strength, Amlodipine 10 mg will be similar to Valsartan 160 mg.

Amlodipine produced by Canonpharm is a Russian analogue of Valsartan. For those who prefer original drugs, there is German-made Norvask.

Prices for the drug and its analogues

The cost of Valsartan substitutes directly depends on the country of origin. Russian-made drugs are cheaper than their foreign counterparts. List of prices for Valsartan analogs and substitutes:

Valsartan or Losartan – which is better?

Manufacturer: JSC Vertex, Russia
Release form: film-coated tablets

Active ingredient: losartan

Synonyms: Lorista. Lozap, Lozarel, Cozaar

Analogs: Candesartan, Giposart, Telmisartan

Both drugs have the same mechanism of action and belong to the sartan group. All analogues of Valsartan for blood pressure in this category of drugs have a serious evidence base.

It has been clinically proven that Valsartan reduces blood pressure more effectively than other sartans in comparable doses, including Losartan. Therefore, when choosing among these drugs, preference is given to Valsartan.

If during treatment adverse reactions are detected or the effect does not occur, replace Valsartan with Lorartan or its synonyms.

General information about Valsartan tablets

Valsartan is a drug from the group of angiotensin receptor antagonists that reduces blood pressure by reducing vascular tone.

It is used mainly in cardiology and is prescribed for primary and secondary arterial hypertension, for chronic functional heart failure, as well as in the post-infarction period to reduce post- and preload on the myocardium.

This drug should not be prescribed if you are allergic to its components, during pregnancy and lactation.

Valsartan or Valsacor – which is better?

Manufacturer: KRKA, Slovenia/Russia
Release form: film-coated tablets

Active ingredient: valsartan

Synonyms: Diovanch

Analogues: Edarbi

Valsacor is the trade name of Valsartan, produced by the Slovenian manufacturer KRKA. In the production of this analogue of Valsartan tablets, a substance is used that does not contain cancer-causing impurities.

The indications do not include a history of myocardial infarction. The safety of use in children has also not been established. For diabetes mellitus, the use of the medication is contraindicated if Aliskiren or ACE inhibitors are prescribed.

It is important to maintain the dosage when replacing one synonym with another. If Valsartan 80 mg is prescribed, the analogue will be Valsacor 80 mg.

According to patient reviews, the drug is well tolerated and effectively reduces blood pressure. Often, when choosing Valsacor among synonyms, the decisive factor is trust in the manufacturer. At the same time, Russian-made Valsartan is more affordable.

Thus, for adult patients with arterial hypertension, the difference between synonyms lies in the manufacturer and cost.

Valsartan or Telmisartan – which is better?

Manufacturer: Ozon LLC, Russia
Release form: tablets

Active ingredient: telmisartan

Synonyms: Mikardis, Telmista

Telmisartan belongs to the group of sartans. Bioavailability averages 50%. The effect of the drug lasts up to 48 hours. Clinical studies have shown that the effect of Telmisartan is comparable to the effect of analogues, while the incidence of side effects, in particular dry cough, was less. The drug is prescribed to reduce the risk of cardiovascular disease and mortality in patients over 55 years of age.

Telmisartan is an analogue of Valsartan with the least side effects.