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class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%AD%E0%AC%BE%E0%AC%B2%E0%AC%B8%E0%AC%BE%E0%AC%B0%E0%AD%8D%E0%AC%9F%E0%AC%BE%E0%AC%A8/%E0%AC%B9%E0%AC%BE%E0%AC%87%E0%AC%A1%E0%AD%8D%E0%AC%B0%E0%AD%8B%E0%AC%95%E0%AD%8D%E0%AC%B2%E0%AD%8B%E0%AC%B0%E0%AD%8B%E0%AC%A5%E0%AC%BF%E0%AC%86%E0%AC%9C%E0%AC%BE%E0%AC%87%E0%AC%A1" title="ଭାଲସାର୍ଟାନ/ହାଇଡ୍ରୋକ୍ଲୋରୋଥିଆଜାଇଡ – Odia" lang="or" hreflang="or" data-title="ଭାଲସାର୍ଟାନ/ହାଇଡ୍ରୋକ୍ଲୋରୋଥିଆଜାଇଡ" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target"><span>ଓଡ଼ିଆ</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/Valsartan/hidrohlorotiazid" title="Valsartan/hidrohlorotiazid – Serbian" lang="sr" hreflang="sr" data-title="Valsartan/hidrohlorotiazid" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" 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.infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox" style="border-spacing:2px;"><caption class="infobox-title"><span title="International nonproprietary name (INN): Valsartan/hydrochlorothiazide">Valsartan/hydrochlorothiazide</span></caption><tbody><tr><td colspan="2" class="infobox-image notheme" style="background-color: #f8f9fa;"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Valsartan.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/4b/Valsartan.svg/220px-Valsartan.svg.png" decoding="async" width="220" height="160" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/4b/Valsartan.svg/330px-Valsartan.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/4b/Valsartan.svg/440px-Valsartan.svg.png 2x" data-file-width="648" data-file-height="472" /></a></span></td></tr><tr><td colspan="2" class="infobox-image notheme" style="background-color: #f8f9fa;"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Hydrochlorothiazide.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/cc/Hydrochlorothiazide.svg/220px-Hydrochlorothiazide.svg.png" decoding="async" width="220" height="134" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/cc/Hydrochlorothiazide.svg/330px-Hydrochlorothiazide.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/cc/Hydrochlorothiazide.svg/440px-Hydrochlorothiazide.svg.png 2x" data-file-width="512" data-file-height="311" /></a></span></td></tr><tr><th colspan="2" class="infobox-header" style="background:#ddd">Combination of</th></tr><tr><th scope="row" class="infobox-label" style="line-height:1.2em;"><a href="/wiki/Valsartan" title="Valsartan">Valsartan</a></th><td class="infobox-data"><a href="/wiki/Angiotensin_II_receptor_antagonist" class="mw-redirect" title="Angiotensin II receptor antagonist">Angiotensin II receptor antagonist</a></td></tr><tr><th scope="row" class="infobox-label" style="line-height:1.2em;"><a href="/wiki/Hydrochlorothiazide" title="Hydrochlorothiazide">Hydrochlorothiazide</a></th><td class="infobox-data"><a href="/wiki/Thiazide" title="Thiazide">Thiazide</a> <a href="/wiki/Diuretic" title="Diuretic">diuretic</a></td></tr><tr><th colspan="2" class="infobox-header" style="background:#ddd">Clinical data</th></tr><tr><th scope="row" class="infobox-label" style="line-height:1.2em;"><a href="/wiki/Drug_nomenclature#Trade_names" title="Drug nomenclature">Trade names</a></th><td class="infobox-data">Co-vasotec, Diovan HCT, Co-Diovan, others</td></tr><tr><th scope="row" class="infobox-label" style="line-height:1.2em;"><a href="/wiki/American_Society_of_Health-System_Pharmacists" title="American Society of Health-System Pharmacists">AHFS</a>/<a href="/wiki/Drugs.com" title="Drugs.com">Drugs.com</a></th><td class="infobox-data"><span title="www.drugs.com"><a rel="nofollow" class="external text" href="https://www.drugs.com/ppa/valsartan-and-hydrochlorothiazide.html">Professional Drug Facts</a></span></td></tr><tr><th scope="row" class="infobox-label" style="line-height:1.2em;"><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></th><td class="infobox-data"><span title="medlineplus.gov"><a rel="nofollow" class="external text" href="https://medlineplus.gov/druginfo/meds/a611032.html">a611032</a></span></td></tr><tr><th scope="row" class="infobox-label" style="line-height:1.2em;"><a href="/wiki/Regulation_of_therapeutic_goods" title="Regulation of therapeutic goods">License data</a></th><td class="infobox-data"><style data-mw-deduplicate="TemplateStyles:r1126788409">.mw-parser-output .plainlist ol,.mw-parser-output .plainlist ul{line-height:inherit;list-style:none;margin:0;padding:0}.mw-parser-output .plainlist ol li,.mw-parser-output .plainlist ul li{margin-bottom:0}</style><div class="plainlist"> <ul><li><small><abbr class="country-name" title="United States">US</abbr></small> <a href="/wiki/DailyMed" title="DailyMed">DailyMed</a>: <span title="dailymed.nlm.nih.gov"><a rel="nofollow" class="external text" href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Valsartan+hydrochlorothiazide">Valsartan hydrochlorothiazide</a></span></li></ul></div> </td></tr><tr><th scope="row" class="infobox-label" style="line-height:1.2em;"><a href="/wiki/Route_of_administration" title="Route of administration">Routes of<br />administration</a></th><td class="infobox-data"><a href="/wiki/Oral_administration" title="Oral administration">By mouth</a></td></tr><tr><th scope="row" class="infobox-label" style="line-height:1.2em;"><a href="/wiki/Anatomical_Therapeutic_Chemical_Classification_System" title="Anatomical Therapeutic Chemical Classification System">ATC code</a></th><td class="infobox-data"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1126788409"><div class="plainlist"><ul><li><a href="/wiki/ATC_code_C09" title="ATC code C09">C09DA03</a> (<span title="www.whocc.no"><a rel="nofollow" class="external text" href="https://www.whocc.no/atc_ddd_index/?code=C09DA03">WHO</a></span>) </li></ul></div></td></tr><tr><th colspan="2" class="infobox-header" style="background:#ddd">Legal status</th></tr><tr><th scope="row" class="infobox-label" style="line-height:1.2em;"><a href="/wiki/Regulation_of_therapeutic_goods" title="Regulation of therapeutic goods">Legal status</a></th><td class="infobox-data"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1126788409"><div class="plainlist"> <ul><li><small><abbr class="country-name" title="United States">US</abbr>:</small> <a href="/wiki/Boxed_warning" title="Boxed warning"><span style="border:thin solid black;">WARNING</span></a><sup id="cite_ref-FDA-AllBoxedWarnings_1-0" class="reference"><a href="#cite_note-FDA-AllBoxedWarnings-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup>Rx-only<sup id="cite_ref-Diovan_HCT_FDA_label_2-0" class="reference"><a href="#cite_note-Diovan_HCT_FDA_label-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></li> <li><small><abbr class="country-name" title="European Union">EU</abbr>:</small> Rx-only<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup></li></ul></div> </td></tr><tr><th colspan="2" class="infobox-header" style="background:#ddd">Identifiers</th></tr><tr><th scope="row" class="infobox-label" style="line-height:1.2em;"><a href="/wiki/CAS_Registry_Number" title="CAS Registry Number">CAS Number</a></th><td class="infobox-data"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1126788409"><div class="plainlist"><ul><li><span title="commonchemistry.cas.org"><a rel="nofollow" class="external text" href="https://commonchemistry.cas.org/detail?cas_rn=186615-83-8">186615-83-8</a></span></li></ul></div></td></tr><tr><th scope="row" class="infobox-label" style="line-height:1.2em;"><a href="/wiki/PubChem#CID" title="PubChem">PubChem</a> <span style="font-weight:normal"><abbr title="Compound ID">CID</abbr></span></th><td class="infobox-data"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1126788409"><div class="plainlist"><ul><li><span title="pubchem.ncbi.nlm.nih.gov"><a rel="nofollow" class="external text" href="https://pubchem.ncbi.nlm.nih.gov/compound/9810581">9810581</a></span></li></ul></div></td></tr><tr><th scope="row" class="infobox-label" style="line-height:1.2em;"><a href="/wiki/KEGG" title="KEGG">KEGG</a></th><td class="infobox-data"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1126788409"><div class="plainlist"><ul><li><span title="www.kegg.jp"><a rel="nofollow" class="external text" href="https://www.kegg.jp/entry/D09197">D09197</a></span><sup> <span typeof="mw:File"><span><img alt="check" src="//upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/7px-Yes_check.svg.png" decoding="async" width="7" height="7" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/11px-Yes_check.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/14px-Yes_check.svg.png 2x" data-file-width="600" data-file-height="600" /></span></span><span style="display:none">Y</span></sup></li></ul></div></td></tr><tr><th scope="row" class="infobox-label" style="line-height:1.2em;"><a href="/wiki/CompTox_Chemicals_Dashboard" title="CompTox Chemicals Dashboard">CompTox Dashboard</a> <span style="font-weight:normal">(<abbr title="U.S. Environmental Protection Agency">EPA</abbr>)</span></th><td class="infobox-data"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1126788409"><div class="plainlist"><ul><li><span title="comptox.epa.gov"><a rel="nofollow" class="external text" href="https://comptox.epa.gov/dashboard/chemical/details/DTXSID40171925">DTXSID40171925</a> <span class="mw-valign-text-top noprint" typeof="mw:File/Frameless"><a href="https://www.wikidata.org/wiki/Q7912612#P3117" title="Edit this at Wikidata"><img alt="Edit this at Wikidata" src="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/10px-OOjs_UI_icon_edit-ltr-progressive.svg.png" decoding="async" width="10" height="10" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/15px-OOjs_UI_icon_edit-ltr-progressive.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png 2x" data-file-width="20" data-file-height="20" /></a></span></span></li></ul></div></td></tr><tr><td colspan="2" class="infobox-below"><style data-mw-deduplicate="TemplateStyles:r886047488">.mw-parser-output .nobold{font-weight:normal}</style><span class="nobold">  <span class="reflink plainlinks nourlexpansion"><a class="external text" href="https://en.wikipedia.org/w/index.php?title=Special:ComparePages&rev1=412259800&page2=Valsartan%2Fhydrochlorothiazide">(verify)</a></span></span></td></tr></tbody></table> <p><b>Valsartan/hydrochlorothiazide</b>, sold under the brand name <b>Diovan HCT</b> among others, is a medication used to treat <a href="/wiki/High_blood_pressure" class="mw-redirect" title="High blood pressure">high blood pressure</a> when <a href="/wiki/Valsartan" title="Valsartan">valsartan</a> is not sufficient.<sup id="cite_ref-BNF76_6-0" class="reference"><a href="#cite_note-BNF76-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> It is a combination of valsartan, an <a href="/wiki/Angiotensin_II_receptor_antagonist" class="mw-redirect" title="Angiotensin II receptor antagonist">angiotensin receptor blocker</a> with <a href="/wiki/Hydrochlorothiazide" title="Hydrochlorothiazide">hydrochlorothiazide</a>, a <a href="/wiki/Diuretic" title="Diuretic">diuretic</a>.<sup id="cite_ref-MTM2019_7-0" class="reference"><a href="#cite_note-MTM2019-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> It is taken by mouth.<sup id="cite_ref-MTM2019_7-1" class="reference"><a href="#cite_note-MTM2019-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p><p>Common side effects include dizziness and headaches.<sup id="cite_ref-MTM2019_7-2" class="reference"><a href="#cite_note-MTM2019-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Serious side effects may include <a href="/wiki/Allergic_reactions" class="mw-redirect" title="Allergic reactions">allergic reactions</a>, <a href="/wiki/Electrolyte_abnormalities" class="mw-redirect" title="Electrolyte abnormalities">electrolyte abnormalities</a>, and <a href="/wiki/Glaucoma" title="Glaucoma">glaucoma</a>.<sup id="cite_ref-Diovan_HCT_FDA_label_2-1" class="reference"><a href="#cite_note-Diovan_HCT_FDA_label-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Use in <a href="/wiki/Pregnancy" title="Pregnancy">pregnancy</a> is not recommended.<sup id="cite_ref-Diovan_HCT_FDA_label_2-2" class="reference"><a href="#cite_note-Diovan_HCT_FDA_label-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>The combination was approved for medical use in the United States in 1998.<sup id="cite_ref-MTM2019_7-3" class="reference"><a href="#cite_note-MTM2019-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> It is available as a <a href="/wiki/Generic_medication" class="mw-redirect" title="Generic medication">generic medication</a>.<sup id="cite_ref-BNF76_6-1" class="reference"><a href="#cite_note-BNF76-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> In 2021, it was the 224th most commonly prescribed medication in the United States, with more than 1<span class="nowrap"> </span>million prescriptions.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Structure–activity_relationship"><span id="Structure.E2.80.93activity_relationship"></span>Structure–activity relationship</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Valsartan/hydrochlorothiazide&action=edit&section=1" title="Edit section: Structure–activity relationship"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Valsartan has the structure that most ARBs have with the extended biphenyl group and tetrazole which mimics the carboxylate group as a bioisostere but is not held to the same metabolic inactivation. One special note about the molecule in terms of how it differs with other angiotensin receptor blockers, is that the molecule at the 2-prime position has a tetrazole, which has an acidic hydrogen attached to it. </p> <div class="mw-heading mw-heading2"><h2 id="Medical_uses">Medical uses</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Valsartan/hydrochlorothiazide&action=edit&section=2" title="Edit section: Medical uses"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="High_blood_pressure">High blood pressure</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Valsartan/hydrochlorothiazide&action=edit&section=3" title="Edit section: High blood pressure"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Valsartan and hydrochlorothiazide are both medications <a href="/wiki/Indication_(medicine)" title="Indication (medicine)">indicated</a> as initial therapy for <a href="/wiki/High_blood_pressure" class="mw-redirect" title="High blood pressure">high blood pressure</a>. When high blood pressure is not effectively controlled on a single medication they can be used in a combination.<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Contraindications">Contraindications</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Valsartan/hydrochlorothiazide&action=edit&section=4" title="Edit section: Contraindications"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The use of valsartan in pregnancy is avoided due to the potential risk of fetal toxicity.<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> The U.S. <a href="/wiki/Food_and_Drug_Administration" title="Food and Drug Administration">Food and Drug Administration</a> has a <a href="/wiki/Black_box_warning" class="mw-redirect" title="Black box warning">black box warning</a> for valsartan/hydrochlorothiazide use during pregnancy.<sup id="cite_ref-Diovan_HCT_FDA_label_2-3" class="reference"><a href="#cite_note-Diovan_HCT_FDA_label-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The use of hydrochlorothiazide is avoided in those with <a href="/wiki/Anuria" title="Anuria">anuria</a> or severe kidney disease.<sup id="cite_ref-:0_12-0" class="reference"><a href="#cite_note-:0-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Adverse_effects">Adverse effects</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Valsartan/hydrochlorothiazide&action=edit&section=5" title="Edit section: Adverse effects"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Side effects that are most often seen with this medication include dizziness, <a href="/wiki/Hypotension" title="Hypotension">hypotension</a>, headache.<sup id="cite_ref-Diovan_HCT_FDA_label_2-4" class="reference"><a href="#cite_note-Diovan_HCT_FDA_label-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> A clinical trial done on over 7000 participants showed higher rates of <a href="/wiki/Common_cold" title="Common cold">nasopharyngitis</a> in those taking valsartan/hydrochlorothiazide (2.4% versus 1.9% in placebo).<sup id="cite_ref-Diovan_HCT_FDA_label_2-5" class="reference"><a href="#cite_note-Diovan_HCT_FDA_label-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:0_12-1" class="reference"><a href="#cite_note-:0-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> A dose-related side effect seen is hypotension, occurring in 0.7% of participants on the highest dose of the medication.<sup id="cite_ref-Diovan_HCT_FDA_label_2-6" class="reference"><a href="#cite_note-Diovan_HCT_FDA_label-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:0_12-2" class="reference"><a href="#cite_note-:0-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Risk of hypotension and <a href="/wiki/Hyperkalemia" title="Hyperkalemia">hyperkalemia</a> increases when valsartan/hydrochlorothiazide is used with <a href="/wiki/ACE_inhibitors" class="mw-redirect" title="ACE inhibitors">ACE inhibitors</a> or <a href="/wiki/Aliskiren" title="Aliskiren">aliskiren</a>.<sup id="cite_ref-Diovan_HCT_FDA_label_2-7" class="reference"><a href="#cite_note-Diovan_HCT_FDA_label-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:2_13-0" class="reference"><a href="#cite_note-:2-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Less common side effects that occur less than 1% of the time include <a href="/wiki/Angina" title="Angina">angina pectoris</a>, <a href="/wiki/Rash" title="Rash">rash</a>, <a href="/wiki/Syncope_(medicine)" title="Syncope (medicine)">syncope</a>, abdominal pain, and <a href="/wiki/Vertigo" title="Vertigo">vertigo</a>.<sup id="cite_ref-Diovan_HCT_FDA_label_2-8" class="reference"><a href="#cite_note-Diovan_HCT_FDA_label-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:0_12-3" class="reference"><a href="#cite_note-:0-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Overdose">Overdose</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Valsartan/hydrochlorothiazide&action=edit&section=6" title="Edit section: Overdose"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Cases of overdose are quite rare. In the event of an overdose people may experience severe <a href="/wiki/Hypotension" title="Hypotension">hypotension</a>, <a href="/wiki/Electrolyte_imbalance" title="Electrolyte imbalance">electrolyte imbalances</a> or <a href="/wiki/Arrhythmia" title="Arrhythmia">abnormal heart rhythms</a>. People are advised to contact emergency services or a poison control centre and are treated based on symptoms.<sup id="cite_ref-Diovan_HCT_FDA_label_2-9" class="reference"><a href="#cite_note-Diovan_HCT_FDA_label-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Interactions">Interactions</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Valsartan/hydrochlorothiazide&action=edit&section=7" title="Edit section: Interactions"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are a few types of medications that interact with <a href="/wiki/Valsartan" title="Valsartan">valsartan</a>. Combined use with <a href="/wiki/Nonsteroidal_anti-inflammatory_drug" title="Nonsteroidal anti-inflammatory drug">nonsteroidal anti-inflammatory drugs</a> (NSAID) such as <a href="/wiki/Naproxen" title="Naproxen">naproxen</a> or <a href="/wiki/Ibuprofen" title="Ibuprofen">ibuprofen</a> can result in kidney injury in people who are elderly, dehydrated, or have reduced kidney function.<sup id="cite_ref-Diovan_HCT_FDA_label_2-10" class="reference"><a href="#cite_note-Diovan_HCT_FDA_label-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> One study conducted Lapi F., et al. found that there was no increased risk of kidney injury when only using either a <a href="/wiki/Diuretic" title="Diuretic">diuretic</a> or <a href="/wiki/Angiotensin_II_receptor_blocker" title="Angiotensin II receptor blocker">angiotensin receptor blocker</a> with an NSAID but did find an increased risk when all three medications were used together.<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Valsartan usage with angiotensin receptor blocker, ACE inhibitors, or aliskiren results in additive side effects.<sup id="cite_ref-:0_12-4" class="reference"><a href="#cite_note-:0-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Pharmacology">Pharmacology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Valsartan/hydrochlorothiazide&action=edit&section=8" title="Edit section: Pharmacology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Valsartan is an angiotensin II receptor blocker this class of drug competes with <a href="/wiki/Angiotensin" title="Angiotensin">angiotensin II</a> for the <a href="/wiki/Angiotensin_type_I_receptor" class="mw-redirect" title="Angiotensin type I receptor">angiotensin type I (AT<sub>1</sub>)</a> receptors located throughout the body.<sup id="cite_ref-Diovan_HCT_FDA_label_2-11" class="reference"><a href="#cite_note-Diovan_HCT_FDA_label-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Angiotensin II is a key component of the <a href="/wiki/Renin%E2%80%93angiotensin_system" title="Renin–angiotensin system">renin-angiotensin-aldosterone system</a> which is responsible for <a href="/wiki/Vasoconstriction" title="Vasoconstriction">vasoconstriction</a> of blood vessels and promotes release of <a href="/wiki/Vasopressin" title="Vasopressin">vasopressin</a> from the <a href="/wiki/Posterior_pituitary" title="Posterior pituitary">posterior pituitary gland</a> of the <a href="/wiki/Hypothalamus" title="Hypothalamus">hypothalamus</a> which helps promote water retention.<sup id="cite_ref-:1_16-0" class="reference"><a href="#cite_note-:1-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Aldosterone" title="Aldosterone">Aldosterone</a> is also released by the <a href="/wiki/Adrenal_gland" title="Adrenal gland">adrenal gland</a> in response to angiotensin II which helps to reabsorb sodium which leads to water reabsorption that results in a rise in blood pressure.<sup id="cite_ref-:1_16-1" class="reference"><a href="#cite_note-:1-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> Blocking angiotensin II from binding to AT<sub>1</sub> receptors will in turn prevent it from raising blood pressure which is why angiotensin II receptor blockers are useful medications in the treatment of blood pressure.<sup id="cite_ref-Diovan_HCT_FDA_label_2-12" class="reference"><a href="#cite_note-Diovan_HCT_FDA_label-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:1_16-2" class="reference"><a href="#cite_note-:1-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Hydrochlorothiazide" title="Hydrochlorothiazide">Hydrochlorothiazide</a> inhibits the <a href="/wiki/Sodium-chloride_symporter" title="Sodium-chloride symporter">NaCl co-transporters</a> in the <a href="/wiki/Distal_convoluted_tubule" title="Distal convoluted tubule">distal convoluted tubule</a> of the <a href="/wiki/Nephron" title="Nephron">nephrons</a> located in the kidneys which are responsible for the excretion of sodium and chloride in exchange for reabsorption of calcium.<sup id="cite_ref-Diovan_HCT_FDA_label_2-13" class="reference"><a href="#cite_note-Diovan_HCT_FDA_label-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:1_16-3" class="reference"><a href="#cite_note-:1-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> Inhibition of the NaCl co-transporters result in water excretion which is believed to be the mechanism of action in diuresis and lowering blood pressure.<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Pharmacokinetics">Pharmacokinetics</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Valsartan/hydrochlorothiazide&action=edit&section=9" title="Edit section: Pharmacokinetics"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Valsartan has an oral <a href="/wiki/Bioavailability" title="Bioavailability">bioavailability</a> of approximately 25% and reaches peak blood concentrations around 2–4 hours after ingestion.<sup id="cite_ref-Diovan_HCT_FDA_label_2-14" class="reference"><a href="#cite_note-Diovan_HCT_FDA_label-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:2_13-1" class="reference"><a href="#cite_note-:2-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> The estimated <a href="/wiki/Elimination_half-life" class="mw-redirect" title="Elimination half-life">elimination half-life</a> is determined to be approximately 6 hours, volume distribution of 17 litres, and a protein binding of 95% is seen.<sup id="cite_ref-:0_12-5" class="reference"><a href="#cite_note-:0-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:2_13-2" class="reference"><a href="#cite_note-:2-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:3_18-0" class="reference"><a href="#cite_note-:3-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> The elderly may see increases in half life of the drug by up to 35% but dosing adjustment will not typically be warranted, however the drug should be used with caution in severe liver or kidney impairment.<sup id="cite_ref-:2_13-3" class="reference"><a href="#cite_note-:2-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Majority of the drug is eliminated through the feces (83%) while only a small portion is eliminated in the urine (13%).<sup id="cite_ref-:3_18-1" class="reference"><a href="#cite_note-:3-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> Most of the drug excreted is unchanged, only small portion of the drug is metabolized to its inactive form 4-hydroxyvaleryl valsartan, the enzyme suspected to be responsible for this is the liver enzyme <a href="/wiki/CYP2C9" title="CYP2C9">CYP2C9</a>.<sup id="cite_ref-:3_18-2" class="reference"><a href="#cite_note-:3-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> Hydrochlorothiazide has an oral bioavailability of 70% and reaches peak concentration around 1.5–2 hours following ingestion. The half-life is quite variable for this drug and can range from 5–15 hours. This drug is not metabolized and is mostly excreted unchanged in the urine (60-70%).<sup id="cite_ref-:2_13-4" class="reference"><a href="#cite_note-:2-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Protein binding ranges between 40 and 70% and volume of distribution varies from 4-8L/kg.<sup id="cite_ref-:0_12-6" class="reference"><a href="#cite_note-:0-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:2_13-5" class="reference"><a href="#cite_note-:2-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Valsartan/hydrochlorothiazide&action=edit&section=10" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-FDA-AllBoxedWarnings-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-FDA-AllBoxedWarnings_1-0">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://nctr-crs.fda.gov/fdalabel/ui/spl-summaries/criteria/343802">"FDA-sourced list of all drugs with black box warnings (Use Download Full Results and View Query links.)"</a>. <i>nctr-crs.fda.gov</i>. <a href="/wiki/FDA" class="mw-redirect" title="FDA">FDA</a><span class="reference-accessdate">. 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template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Agents_acting_on_the_renin%E2%80%93angiotensin_system" title="Template talk:Agents acting on the renin–angiotensin system"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Agents_acting_on_the_renin%E2%80%93angiotensin_system" title="Special:EditPage/Template:Agents acting on the renin–angiotensin system"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Antihypertensive_drugs_acting_on_the_renin–angiotensin_system_(C09)" style="font-size:114%;margin:0 4em"><a href="/wiki/Antihypertensive_drug" class="mw-redirect" title="Antihypertensive drug">Antihypertensive drugs</a> acting on the <a href="/wiki/Renin%E2%80%93angiotensin_system" title="Renin–angiotensin system">renin–angiotensin system</a> (<a href="/wiki/ATC_code_C09" title="ATC code C09">C09</a>)</div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/ACE_inhibitor" title="ACE inhibitor">ACE inhibitors</a><br />("-pril")</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/ACE_inhibitor#Sulfhydryl-containing_agents" title="ACE inhibitor">Sulfhydryl-containing</a>:</i> <a href="/wiki/Captopril" title="Captopril">Captopril</a></li> <li><a href="/wiki/Rentiapril" title="Rentiapril">Rentiapril</a></li> <li><a href="/wiki/Zofenopril" title="Zofenopril">Zofenopril</a><span class="nowrap"> </span>(<a href="/w/index.php?title=Zofenopril/nebivolol&action=edit&redlink=1" class="new" title="Zofenopril/nebivolol (page does not exist)">+nebivolol</a>)</li> <li><i><a href="/wiki/ACE_inhibitor#Dicarboxylate-containing_agents" title="ACE inhibitor">Dicarboxylate-containing</a>: </i><a href="/wiki/Enalapril" title="Enalapril">Enalapril</a><sup>#</sup> (<a href="/w/index.php?title=Enalapril/lercanidipine&action=edit&redlink=1" class="new" title="Enalapril/lercanidipine (page does not exist)">+lercanidipine</a>, <a href="/w/index.php?title=Enalapril/nitrendipine&action=edit&redlink=1" class="new" title="Enalapril/nitrendipine (page does not exist)">+nitrendipine</a>)</li> <li><a href="/wiki/Benazepril" title="Benazepril">Benazepril</a><span class="nowrap"> </span>(<a href="/wiki/Benazepril/amlodipine" class="mw-redirect" title="Benazepril/amlodipine">+amlodipine</a>, <a href="/w/index.php?title=Benazepril/pimobendan&action=edit&redlink=1" class="new" title="Benazepril/pimobendan (page does not exist)">+pimobendan</a>)</li> <li><a href="/wiki/Cilazapril" title="Cilazapril">Cilazapril</a></li> <li><a href="/wiki/Delapril" title="Delapril">Delapril</a><span class="nowrap"> </span>(<a href="/w/index.php?title=Delapril/manidipine&action=edit&redlink=1" class="new" title="Delapril/manidipine (page does not exist)">+manidipine</a>)</li> <li><a href="/wiki/Imidapril" title="Imidapril">Imidapril</a></li> <li><a href="/wiki/Lisinopril" title="Lisinopril">Lisinopril</a><span class="nowrap"> </span>(<a href="/wiki/Lisinopril/amlodipine" title="Lisinopril/amlodipine">+amlodipine</a>, <a href="/wiki/Lisinopril/hydrochlorothiazide" title="Lisinopril/hydrochlorothiazide">+HCT</a>)</li> <li><a href="/wiki/Moexipril" title="Moexipril">Moexipril</a></li> <li><a href="/wiki/Perindopril" title="Perindopril">Perindopril</a><span class="nowrap"> </span>(<a href="/wiki/Perindopril/amlodipine" class="mw-redirect" title="Perindopril/amlodipine">+amlodipine</a>, <a href="/w/index.php?title=Perindopril/bisoprolol&action=edit&redlink=1" class="new" title="Perindopril/bisoprolol (page does not exist)">+bisoprolol</a>, <a href="/wiki/Perindopril/indapamide" title="Perindopril/indapamide">+indapamide</a>, <a href="/w/index.php?title=Perindopril/amlodipine/indapamide&action=edit&redlink=1" class="new" title="Perindopril/amlodipine/indapamide (page does not exist)">+amlodipine and indapamide</a>, <a href="/w/index.php?title=Perindopril/bisoprolol/amlodipine&action=edit&redlink=1" class="new" title="Perindopril/bisoprolol/amlodipine (page does not exist)">+bisoprolol and amlodipine</a>, <a href="/w/index.php?title=Perindopril/bisoprolol/amlodipine/indapamide&action=edit&redlink=1" class="new" title="Perindopril/bisoprolol/amlodipine/indapamide (page does not exist)">+bisoprolol, amlodipine, and indapamide</a>)</li> <li><a href="/wiki/Quinapril" title="Quinapril">Quinapril</a><span class="nowrap"> </span>(<a href="/wiki/Quinapril/hydrochlorothiazide" class="mw-redirect" title="Quinapril/hydrochlorothiazide">+HCT</a>)</li> <li><a href="/wiki/Ramipril" title="Ramipril">Ramipril</a><span class="nowrap"> </span>(<a href="/w/index.php?title=Ramipril/amlodipine&action=edit&redlink=1" class="new" title="Ramipril/amlodipine (page does not exist)">+amlodipine</a>, <a href="/w/index.php?title=Ramipril/amlodipine/hydrochlorothiazide&action=edit&redlink=1" class="new" title="Ramipril/amlodipine/hydrochlorothiazide (page does not exist)">+amlodipine and HCT</a>, <a href="/w/index.php?title=Ramipril/bisoprolol&action=edit&redlink=1" class="new" title="Ramipril/bisoprolol (page does not exist)">+bisoprolol</a>, <a href="/w/index.php?title=Ramipril/felodipine&action=edit&redlink=1" class="new" title="Ramipril/felodipine (page does not exist)">+felodipine</a>)</li> <li><a href="/wiki/Spirapril" title="Spirapril">Spirapril</a></li> <li><a href="/wiki/Temocapril" title="Temocapril">Temocapril</a></li> <li><a href="/wiki/Trandolapril" title="Trandolapril">Trandolapril</a><span class="nowrap"> </span>(<a href="/wiki/Trandolapril/verapamil" title="Trandolapril/verapamil">+verapamil</a>)</li> <li><i><a href="/wiki/ACE_inhibitor#Phosphonate-containing_agents" title="ACE inhibitor">Phosphonate-containing</a></i>: <a href="/wiki/Ceronapril" title="Ceronapril">Ceronapril</a></li> <li><a href="/wiki/Fosinopril" title="Fosinopril">Fosinopril</a><span class="nowrap"> </span>(<a href="/wiki/Fosinopril/hydrochlorothiazide" class="mw-redirect" title="Fosinopril/hydrochlorothiazide">+HCT</a>)</li> <li><i>Other/ungrouped:</i> <a href="/wiki/Alacepril" title="Alacepril">Alacepril</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Angiotensin_II_receptor_antagonist" class="mw-redirect" title="Angiotensin II receptor antagonist">AIIRAs</a><br />("-sartan")</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Azilsartan" title="Azilsartan">Azilsartan</a></li> <li><a href="/wiki/Candesartan" title="Candesartan">Candesartan</a><span class="nowrap"> </span>(<a href="/w/index.php?title=Candesartan/amlodipine&action=edit&redlink=1" class="new" title="Candesartan/amlodipine (page does not exist)">+amlodipine</a>, <a href="/w/index.php?title=Candesartan/amlodipine/hydrochlorothiazide&action=edit&redlink=1" class="new" title="Candesartan/amlodipine/hydrochlorothiazide (page does not exist)">+amlodipine and HCT</a>)</li> <li><a href="/wiki/Eprosartan" title="Eprosartan">Eprosartan</a></li> <li><a href="/wiki/Fimasartan" title="Fimasartan">Fimasartan</a></li> <li><a href="/wiki/Irbesartan" title="Irbesartan">Irbesartan</a><span class="nowrap"> </span>(<a href="/w/index.php?title=Irbesartan/amlodipine&action=edit&redlink=1" class="new" title="Irbesartan/amlodipine (page does not exist)">+amlodipine</a>, <a href="/w/index.php?title=Irbesartan/amlodipine/hydrochlorothiazide&action=edit&redlink=1" class="new" title="Irbesartan/amlodipine/hydrochlorothiazide (page does not exist)">+amlodipine and HCT</a>, <a href="/wiki/Irbesartan/hydrochlorothiazide" class="mw-redirect" title="Irbesartan/hydrochlorothiazide">+HCT</a>)</li> <li><a href="/wiki/Losartan" title="Losartan">Losartan</a><span class="nowrap"> </span>(<a href="/w/index.php?title=Losartan/amlodipine&action=edit&redlink=1" class="new" title="Losartan/amlodipine (page does not exist)">+amlodipine</a>, <a href="/wiki/Losartan/hydrochlorothiazide" title="Losartan/hydrochlorothiazide">+HCT</a>)</li> <li><a href="/wiki/Olmesartan" title="Olmesartan">Olmesartan</a><span class="nowrap"> </span>(<a href="/wiki/Amlodipine/olmesartan" title="Amlodipine/olmesartan">+amlodipine</a>, <a href="/wiki/Olmesartan/amlodipine/hydrochlorothiazide" title="Olmesartan/amlodipine/hydrochlorothiazide">+amlodipine and HCT</a>, <a href="/wiki/Olmesartan/hydrochlorothiazide" title="Olmesartan/hydrochlorothiazide">+HCT</a>)</li> <li><a href="/wiki/Tasosartan" title="Tasosartan">Tasosartan</a><sup>§</sup></li> <li><a href="/wiki/Telmisartan" title="Telmisartan">Telmisartan</a><span class="nowrap"> </span>(<a href="/wiki/Telmisartan/amlodipine" title="Telmisartan/amlodipine">+amlodipine</a>, <a href="/w/index.php?title=Telmisartan/amlodipine/hydrochlorothiazide&action=edit&redlink=1" class="new" title="Telmisartan/amlodipine/hydrochlorothiazide (page does not exist)">+amlodipine and HCT</a>, <a href="/wiki/Telmisartan/hydrochlorothiazide" title="Telmisartan/hydrochlorothiazide">+HCT</a>)</li> <li><a href="/wiki/Valsartan" title="Valsartan">Valsartan</a><span class="nowrap"> </span>(<a href="/w/index.php?title=Valsartan/aliskiren&action=edit&redlink=1" class="new" title="Valsartan/aliskiren (page does not exist)">+aliskiren</a>, <a href="/wiki/Amlodipine/valsartan" title="Amlodipine/valsartan">+amlodipine</a>, <a href="/wiki/Amlodipine/valsartan/hydrochlorothiazide" class="mw-redirect" title="Amlodipine/valsartan/hydrochlorothiazide">+amlodipine and HCT</a>, <a class="mw-selflink selflink">+HCT</a>, <a href="/w/index.php?title=Valsartan/lercanidipine&action=edit&redlink=1" class="new" title="Valsartan/lercanidipine (page does not exist)">+lercanidipine</a>, <a href="/wiki/Nebivolol/valsartan" title="Nebivolol/valsartan">+nebivolol</a>, <a href="/wiki/Sacubitril/valsartan" title="Sacubitril/valsartan">+sacubitril</a>)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Renin_inhibitor" title="Renin inhibitor">Renin inhibitors</a><br />("-kiren")</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Aliskiren" title="Aliskiren">Aliskiren</a><span class="nowrap"> </span>(<a href="/wiki/Aliskiren/amlodipine" title="Aliskiren/amlodipine">+amlodipine</a>, <a href="/wiki/Aliskiren/hydrochlorothiazide" title="Aliskiren/hydrochlorothiazide">+HCT</a>, <a href="/wiki/Aliskiren/amlodipine/hydrochlorothiazide" title="Aliskiren/amlodipine/hydrochlorothiazide">+amlodipine and HCT</a>)</li> <li><a href="/wiki/Remikiren" title="Remikiren">Remikiren</a><sup>§</sup></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Dual <a href="/wiki/Angiotensin-converting_enzyme" title="Angiotensin-converting enzyme">ACE</a>/<a href="/wiki/Neprilysin" title="Neprilysin">NEP</a> inhibitors</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Gemopatrilat" title="Gemopatrilat">Gemopatrilat</a></li> <li><a href="/w/index.php?title=Ilepatril&action=edit&redlink=1" class="new" title="Ilepatril (page does not exist)">Ilepatril</a></li> <li><a href="/wiki/Omapatrilat" title="Omapatrilat">Omapatrilat</a></li> <li><a href="/w/index.php?title=Sampatrilat&action=edit&redlink=1" class="new" title="Sampatrilat (page does not exist)">Sampatrilat</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Neprilysin" title="Neprilysin">Neprilysin</a> inhibitors</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Sacubitril" title="Sacubitril">Sacubitril</a><span class="nowrap"> </span>(<a href="/wiki/Sacubitril/valsartan" title="Sacubitril/valsartan">+valsartan</a>)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Sparsentan" title="Sparsentan">Sparsentan</a></li></ul> </div></td></tr><tr><td class="navbox-abovebelow" colspan="2" style="background: transparent; padding: 0px;"><div><div class="hlist"> <ul><li><sup>#</sup><a href="/wiki/WHO_Model_List_of_Essential_Medicines" title="WHO Model List of Essential Medicines">WHO-EM</a></li> <li><sup>‡</sup><a href="/wiki/List_of_withdrawn_drugs" title="List of withdrawn drugs">Withdrawn</a> from market</li> <li><a href="/wiki/Clinical_trial" title="Clinical trial">Clinical trials</a>: <ul><li><sup>†</sup><a href="/wiki/Phases_of_clinical_research#Phase_III" title="Phases of clinical research">Phase III</a></li> <li><sup>§</sup>Never to phase III</li></ul></li></ul> </div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Angiotensin_receptor_modulators" style="padding:3px"><table class="nowraplinks hlist mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Angiotensin_receptor_modulators" title="Template:Angiotensin receptor modulators"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Angiotensin_receptor_modulators" title="Template talk:Angiotensin receptor modulators"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Angiotensin_receptor_modulators" title="Special:EditPage/Template:Angiotensin receptor modulators"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Angiotensin_receptor_modulators" style="font-size:114%;margin:0 4em"><a href="/wiki/Angiotensin_receptor" class="mw-redirect" title="Angiotensin receptor">Angiotensin receptor</a> <a href="/wiki/Receptor_modulator" title="Receptor modulator">modulators</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><a href="/wiki/Angiotensin_receptor" class="mw-redirect" title="Angiotensin receptor"><abbr title="Angiotensin receptor">ATR</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip Angiotensin receptor</span></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i>Agonists:</i> <a href="/wiki/Angiotensin_II" class="mw-redirect" title="Angiotensin II">Angiotensin II</a></li> <li><a href="/wiki/Angiotensin_III" class="mw-redirect" title="Angiotensin III">Angiotensin III</a></li> <li><a href="/wiki/Angiotensin_IV" class="mw-redirect" title="Angiotensin IV">Angiotensin IV</a></li> <li><a href="/wiki/L-163,491" title="L-163,491">L-163,491</a></li> <li><a href="/wiki/Saralasin" title="Saralasin">Saralasin</a></li></ul> <ul><li><i>Antagonists:</i> <a href="/wiki/Abitesartan" title="Abitesartan">Abitesartan</a></li> <li><a href="/wiki/Azilsartan" title="Azilsartan">Azilsartan</a></li> <li><a href="/wiki/Candesartan" title="Candesartan">Candesartan</a></li> <li><a href="/w/index.php?title=Elisartan&action=edit&redlink=1" class="new" title="Elisartan (page does not exist)">Elisartan</a></li> <li><a href="/w/index.php?title=Embusartan&action=edit&redlink=1" class="new" title="Embusartan (page does not exist)">Embusartan</a></li> <li><a href="/wiki/Eprosartan" title="Eprosartan">Eprosartan</a></li> <li><a href="/w/index.php?title=EXP-3174&action=edit&redlink=1" class="new" title="EXP-3174 (page does not exist)">EXP-3174</a></li> <li><a href="/wiki/Fimasartan" title="Fimasartan">Fimasartan</a></li> <li><a href="/wiki/Forasartan" title="Forasartan">Forasartan</a></li> <li><a href="/wiki/Irbesartan" title="Irbesartan">Irbesartan</a></li> <li><a href="/wiki/Losartan" title="Losartan">Losartan</a></li> <li><a href="/w/index.php?title=Milfasartan&action=edit&redlink=1" class="new" title="Milfasartan (page does not exist)">Milfasartan</a></li> <li><a href="/wiki/Olmesartan" title="Olmesartan">Olmesartan</a></li> <li><a href="/w/index.php?title=Olodanrigan&action=edit&redlink=1" class="new" title="Olodanrigan (page does not exist)">Olodanrigan</a></li> <li><a href="/w/index.php?title=PD123319&action=edit&redlink=1" class="new" title="PD123319 (page does not exist)">PD123319</a></li> <li><a href="/w/index.php?title=Pomisartan&action=edit&redlink=1" class="new" title="Pomisartan (page does not exist)">Pomisartan</a></li> <li><a href="/w/index.php?title=Pratosartan&action=edit&redlink=1" class="new" title="Pratosartan (page does not exist)">Pratosartan</a></li> <li><a href="/w/index.php?title=Ripisartan&action=edit&redlink=1" class="new" title="Ripisartan (page does not exist)">Ripisartan</a></li> <li><a href="/w/index.php?title=Saprisartan&action=edit&redlink=1" class="new" title="Saprisartan (page does not exist)">Saprisartan</a></li> <li><a href="/wiki/Sparsentan" title="Sparsentan">Sparsentan</a></li> <li><a href="/wiki/Tasosartan" title="Tasosartan">Tasosartan</a></li> <li><a href="/wiki/Telmisartan" title="Telmisartan">Telmisartan</a></li> <li><a href="/wiki/Valsartan" title="Valsartan">Valsartan</a></li> <li><a href="/w/index.php?title=Zolasartan&action=edit&redlink=1" class="new" title="Zolasartan (page does not exist)">Zolasartan</a></li></ul> <ul><li><i><abbr title="Angiotensin-converting-enzyme">ACE</abbr> inhibitors:</i> <a href="/wiki/Alacepril" title="Alacepril">Alacepril</a></li> <li><a href="/wiki/Benazepril" title="Benazepril">Benazepril</a></li> <li><a href="/wiki/Captopril" title="Captopril">Captopril</a></li> <li><a href="/wiki/Cilazapril" title="Cilazapril">Cilazapril</a></li> <li><a href="/wiki/Delapril" title="Delapril">Delapril</a></li> <li><a href="/wiki/Enalapril" title="Enalapril">Enalapril</a></li> <li><a href="/wiki/Enalaprilat" title="Enalaprilat">Enalaprilat</a></li> <li><a href="/wiki/Fosinopril" title="Fosinopril">Fosinopril</a></li> <li><a href="/wiki/Gemopatrilat" title="Gemopatrilat">Gemopatrilat</a></li> <li><a href="/wiki/Imidapril" title="Imidapril">Imidapril</a></li> <li><a href="/wiki/Lisinopril" title="Lisinopril">Lisinopril</a></li> <li><a href="/wiki/Moexipril" title="Moexipril">Moexipril</a></li> <li><a href="/wiki/Omapatrilat" title="Omapatrilat">Omapatrilat</a></li> <li><a href="/wiki/Perindopril" title="Perindopril">Perindopril</a></li> <li><a href="/wiki/Quinapril" title="Quinapril">Quinapril</a></li> <li><a href="/wiki/Quinaprilat" title="Quinaprilat">Quinaprilat</a></li> <li><a href="/wiki/Ramipril" title="Ramipril">Ramipril</a></li> <li><a href="/wiki/Rentiapril" title="Rentiapril">Rentiapril</a></li> <li><a href="/wiki/Rescinnamine" title="Rescinnamine">Rescinnamine</a></li> <li><a href="/wiki/Spirapril" title="Spirapril">Spirapril</a></li> <li><a href="/wiki/Spiraprilat" title="Spiraprilat">Spiraprilat</a></li> <li><a href="/wiki/Temocapril" title="Temocapril">Temocapril</a></li> <li><a href="/wiki/Trandolapril" title="Trandolapril">Trandolapril</a></li> <li><a href="/wiki/Zofenopril" title="Zofenopril">Zofenopril</a></li> <li><a href="/wiki/Zofenoprilat" title="Zofenoprilat">Zofenoprilat</a></li></ul> <ul><li><i>Renin inhibitors:</i> <a href="/wiki/Aliskiren" title="Aliskiren">Aliskiren</a></li> <li><a href="/w/index.php?title=Ciprokiren&action=edit&redlink=1" class="new" title="Ciprokiren (page does not exist)">Ciprokiren</a></li> <li><a href="/w/index.php?title=Ditekiren&action=edit&redlink=1" class="new" title="Ditekiren (page does not exist)">Ditekiren</a></li> <li><a href="/w/index.php?title=Enalkiren&action=edit&redlink=1" class="new" title="Enalkiren (page does not exist)">Enalkiren</a></li> <li><a href="/w/index.php?title=Imarikiren&action=edit&redlink=1" class="new" title="Imarikiren (page does not exist)">Imarikiren</a></li> <li><a href="/wiki/Pepstatin" title="Pepstatin">Pepstatin</a></li> <li><a href="/wiki/Remikiren" title="Remikiren">Remikiren</a></li> <li><a href="/w/index.php?title=Terlakiren&action=edit&redlink=1" class="new" title="Terlakiren (page does not exist)">Terlakiren</a></li> <li><a href="/w/index.php?title=Zankiren&action=edit&redlink=1" class="new" title="Zankiren (page does not exist)">Zankiren</a></li></ul> <ul><li><i>Propeptides:</i> <a href="/wiki/Angiotensinogen" class="mw-redirect" title="Angiotensinogen">Angiotensinogen</a></li> <li><a href="/wiki/Angiotensin_I" class="mw-redirect" title="Angiotensin I">Angiotensin I</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><i>Combinations:</i></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Amlodipine/valsartan" title="Amlodipine/valsartan">Amlodipine/valsartan</a></li> <li><a href="/wiki/Olmesartan/amlodipine" class="mw-redirect" title="Olmesartan/amlodipine">Olmesartan/amlodipine</a></li> <li><a href="/wiki/Olmesartan/amlodipine/hydrochlorothiazide" title="Olmesartan/amlodipine/hydrochlorothiazide">Olmesartan/amlodipine/hydrochlorothiazide</a></li> <li><a class="mw-selflink selflink">Valsartan/hydrochlorothiazide</a></li> <li><a href="/wiki/Valsartan/hydrochlorothiazide/amlodipine" class="mw-redirect" title="Valsartan/hydrochlorothiazide/amlodipine">Valsartan/hydrochlorothiazide/amlodipine</a></li></ul> </div></td></tr></tbody></table></div> <style data-mw-deduplicate="TemplateStyles:r1130092004">.mw-parser-output .portal-bar{font-size:88%;font-weight:bold;display:flex;justify-content:center;align-items:baseline}.mw-parser-output .portal-bar-bordered{padding:0 2em;background-color:#fdfdfd;border:1px solid #a2a9b1;clear:both;margin:1em auto 0}.mw-parser-output .portal-bar-related{font-size:100%;justify-content:flex-start}.mw-parser-output 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