Sacubitril Valsartan
Contraindicated
Textbook
Potentially excessive hypotension, increased risk of adverse effects.
Do not use in conjunction with other ARBs.
Source: G&G 14e · p602
Drug reference
Valsartan
Angiotensin II receptor blocker (ARB) · Antihypertensive
START
HTN 80–160 mg/day; HFrEF 40 mg BID titrate to 160 mg BID
TYPICAL MAX
320 mg/day (HTN); 160 mg BID (HF)
STOP IF
Pregnancy, angioedema, K+ >6.0, AKI (creatinine rise >30%)
WATCH
BP, K+ and creatinine 1–2 weeks after start/titration, pregnancy status
CDSCO approvedSchedule HATC C09CA03
KDIGO 2024 + manufacturer label
- ONSET
- 2h · BP onset
- PEAK
- 3h · Cmax
- t½
- 6h · plasma t½
- DURATION
- 1d · once-daily effect
EXCRETION
~83% biliary/faecal, ~13% renal; minimal metabolism
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Contraindicated 2nd/3rd trimester (fetal renal/skull injury, death); discontinue immediately if pregnancy detected
FDA category + note
Top interactionssee all 12 →
- Sacubitril ValsartanContraindicatedTextbookG&G 14e · p602
- AliskirenContraindicatedDatabaseKimi deep-research + Cla
- Angiotensin Converting Enzyme InhibitorsSevereTextbookHarrison 22e · p2396
- EnalaprilatSevereTextbookG&G 14e
Available in India
30 branded formulations and 16 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Mechanism
Selective AT1-receptor antagonism, blocking angiotensin II–mediated vasoconstriction and aldosterone release → reduced BP, afterload and adverse cardiac/renal remodelling; does not affect bradykinin (less cough than ACE inhibitors).
Indications
HypertensionHeart failure (reduced ejection fraction)Post-myocardial-infarction with LV dysfunctionDiabetic/proteinuric nephropathy (renoprotection)
Dosing
- Adult
- Hypertension: 80–160 mg PO once daily (max 320 mg). Heart failure: 40 mg BID, titrate to 160 mg BID. Post-MI: 20 mg BID titrated to 160 mg BID.
- Pediatric
- ≥6 years hypertension: ~1.3 mg/kg once daily (max 40 mg) titrated.
- Renal adjustment
- No initial adjustment; caution and monitor K+/creatinine in significant impairment.
- Hepatic adjustment
- Mild–moderate: no routine adjustment. Severe/biliary obstruction: caution, lower dose.
- Geriatric
- No specific adjustment; monitor BP/renal function.
- Max dose
- 320 mg/day (hypertension); 160 mg BID (HF)
Pharmacokinetics
Onset
~2 h (BP); 2 weeks for full effect
Peak effect
2–4 h
Duration
~24 h
Half-life
~6 h
Bioavailability
~25% (food reduces ~40%, not clinically significant)
Protein binding
~95%
Metabolism
Minimal hepatic (mostly unchanged)
Excretion
~83% faecal/biliary, ~13% renal
Contraindications
- Pregnancy (2nd/3rd trimester — fetal toxicity)
- Bilateral renal artery stenosis
- Concomitant aliskiren in diabetes
- Hypersensitivity/angioedema with ARB
- Severe hepatic impairment/biliary obstruction (caution)
Side effects
Common
DizzinessHypotensionHeadacheFatigueHyperkalaemia (esp. with renal impairment/K-sparing)
Serious
- Angioedema (less than ACE-I)
- Acute kidney injury (bilateral RAS, volume depletion)
- Severe hyperkalaemia
- Symptomatic hypotension; fetal toxicity
Pregnancy & lactation
Pregnancy
Contraindicated 2nd/3rd trimester (fetal renal/skull injury, death); discontinue immediately if pregnancy detected
Lactation
Limited data; alternatives preferred — avoid
Drug interactions
Aliskiren
Contraindicated
Database
Dual RAAS blockade → hyperkalaemia, hypotension, AKI
Do not combine in diabetes or eGFR <60
Source: Kimi deep-research + Cla
Angiotensin Converting Enzyme Inhibitors
Severe
Textbook
Greater incidence of acute kidney injury (AKI) and adverse cardiac events.
The combination of these two classes should be avoided.
Source: Harrison 22e · p2396
Enalaprilat
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Imidapril
Severe
Textbook
Greater incidence of acute kidney injury (AKI) and adverse cardiac events.
The combination of these two classes should be avoided.
Source: Harrison 22e · p2396
Rifampin
Severe
Textbook
valsartan AUC increased 5.5-fold.
coadministration generally contraindicate[d] or at least require[s] dosage adjustment.
Source: G&G 14e · p1591
Amiloride
Severe
Database
Hyperkalemia.
Monitor K+ levels.
Source: DDInter
Benazepril
Severe
Database
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: DDInter
Captopril
Severe
Database
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: DDInter
Enalapril
Severe
Database
Does not affect prognosis in heart failure patients, but increases hypotension, hyperkalemia, and renal dysfunction.
There is no routine indication for this combination.
Source: DDInter
Fosinopril
Severe
Database
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: DDInter
Lisinopril
Severe
Database
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: DDInter
Related guidelines
Other Angiotensin II receptor blocker (ARB) drugs
Ask House about Valsartan
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19