No interaction In drug interaction studies with valsartan, no interactions of clinical significance have been found with valsartan or any of the following substances: Digoxin and indomethacin could interact with the hydrochlorothiazide component of Co-Diovan see interactions related to hydrochlorothiazide.
Interactions related to hydrochlorothiazide Concomitant use requiring caution Medicinal products affecting serum potassium level The hypokalaemic effect of hydrochlorothiazide may be increased by concomitant administration of kaliuretic diuretics, corticosteroids, laxatives, ACTH, amphotericin, carbenoxolone, penicillin G, salicylic acid and derivatives.
If these medicinal products are to be prescribed with the hydrochlorothiazide-valsartan combination, monitoring of potassium plasma levels is advised see section 4. Medicinal products that could induce torsades de pointes Due to the risk of hypokalaemia, hydrochlorothiazide should be administered with caution when associated with medicinal products that could induce torsades de pointes, in particular Class Ia and Class III antiarrhythmics and some antipsychotics.
Medicinal products affecting serum sodium level The hyponatraemic effect of diuretics may be intensified by concomitant administration of drugs such as antidepressants, antipsychotics, antiepileptics, etc. Caution is advised in long-term administration of these drugs. Digitalis glycosides Thiazide-induced hypokalaemia or hypomagnesaemia may occur as undesirable effects favouring the onset of digitalis-induced cardiac arrhythmias see section 4.
Calcium salts and vitamin D Administration of thiazide diuretics, including hydrochlorothiazide, with vitamin D or with calcium salts may potentiate the rise in serum calcium.
Concomitant use of thiazide type diuretics with calcium salts may cause hypercalcaemia in patients pre-disposed for hypercalcaemia e. Antidiabetic agents oral agents and insulin Thiazides may alter glucose tolerance. Dose adjustment of the antidiabetic medicinal product may be necessary. Metformin should be used with caution because of the risk of lactic acidosis induced by possible functional renal failure linked to hydrochlorothiazide.
Beta blockers and diazoxide Concomitant use of thiazide diuretics, including hydrochlorothiazide, with beta blockers may increase the risk of hyperglycaemia. Thiazide diuretics, including hydrochlorothiazide, may enhance the hyperglycaemic effect of diazoxide. Medicinal products used in the treatment of gout probenecid, sulfinpyrazone and allopurinol Dose adjustment of uricosuric medications may be necessary as hydrochlorothiazide may raise the level of serum uric acid. Increase of dosage of probenecid or sulfinpyrazone may be necessary.
Co-administration of thiazide diuretics, including hydrochlorothiazide, may increase the incidence of hypersensitivity reactions to allopurinol. Anticholinergic agents and other medicinal products affecting gastric motility The bioavailability of thiazide-type diuretics may be increased by anticholinergic agents e.
Conversely, it is anticipated that prokinetic drugs such as cisapride may decrease the bioavailability of thiazide-type diuretics. Amantadine Thiazides, including hydrochlorothiazide, may increase the risk of adverse effects caused by amantadine. Ion exchange resins Absorption of thiazide diuretics, including hydrochlorothiazide, is decreased by cholestyramine or colestipol.
This could result in sub-therapeutic effects of thiazide diuretics. However, staggering the dosage of hydrochlorothiazide and resin such that hydrochlorothiazide is administered at least 4 h before or h after the administration of resins would potentially minimise the interaction.
Cytotoxic agents Thiazides, including hydrochlorothiazide, may reduce renal excretion of cytotoxic agents e. Non-depolarising skeletal muscle relaxants e. Ciclosporin Concomitant treatment with ciclosporin may increase the risk of hyperuricaemia and gout-type complications. Alcohol, barbiturates or narcotics Concomitant administration of thiazide diuretics with substances that also have a blood pressure lowering effect e. Methyldopa There have been isolated reports of haemolytic anaemia in patients receiving concomitant treatment with methyldopa and hydrochlorothiazide.
Iodine contrast media In case of diuretic-induced dehydration, there is an increased risk of acute renal failure, especially with high doses of the iodine product. Patients should be rehydrated before the administration.
This is a combination product that contains 2 medications: This combination medication is used to treat high blood pressure. Valsartan belongs to the class of medications called angiotensin II receptor blockers and helps to lower blood pressure by relaxing blood vessels. Hydrochlorothiazide belongs to the class of medications called diuretics or "water pills" and helps control blood pressure by getting rid of excess salt and water. The full effects of this combination product are usually seen within about 4 weeks.
This medication is most often used when a person has taken valsartan and hydrochlorothiazide as separate medications without any problems. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here. Your doctor may have suggested this medication for conditions other than those listed in these drug information articles.
Patients receiving amifostine at doses recommended for chemotherapy should have antihypertensive therapy interrupted 24 hours preceding administration of amifostine. If the antihypertensive cannot be stopped, patients should not receive amifostine.
Major Patients receiving antihypertensive agents should be closely monitored during amifostine infusions due to additive effects.
If possible, patients should not take their antihypertensive medication 24 hours before receiving amifostine. Patients who can not stop their antihypertensive agents should not receive amifostine or be closely monitored during the infusion and, possibly, given lower doses. Major Potassium-sparing diuretics, such as amiloride, should be used with caution in patients taking drugs that may increase serum potassium levels such as angiotensin II receptor antagonists. Major Since antiarrhythmic drugs may be ineffective or may be arrhythmogenic in patients with hypokalemia, any potassium or magnesium deficiency should be corrected before instituting and during amiodarone therapy.
Use caution when coadministering amiodarone with drugs which may induce hypokalemia and, or hypomagnesemia including thiazide diuretics. Moderate Patients with hyponatremia or hypovolemia are more susceptible to developing reversible renal insufficiency when given angiotensin converting enzyme ACE inhibitors and diuretics concomitantly. Moderate Concurrent use of amobarbital with antihypertensive agents may lead to hypotension.
Monitor for decreases in blood pressure during times of coadministration. Moderate Proton pump inhibitors have been associated with hypomagnesemia. Hypomagnesemia occurs with thiazide diuretics chlorothiazide, hydrochlorothiazide, indapamide, and metolazone. Low serum magnesium may lead to serious adverse events such as muscle spasm, seizures, and arrhythmias. Therefore, clinicians should monitor serum magnesium concentrations periodically in patients taking a PPI and diuretics concomitantly.
Patients who develop hypomagnesemia may require PPI discontinuation in addition to magnesium replacement. Major Amphetamines increase both systolic and diastolic blood pressure and may counteract the activity of some antihypertensive agents, such as angiotensin II receptor antagonists. Close monitoring of blood pressure or the selection of alternative therapeutic agents may be needed.
Major Amphetamines increase both systolic and diastolic blood pressure and may counteract the activity of some antihypertensive agents. Due to the risk of unopposed alpha-adrenergic activity, amphetamines should be used cautiously with beta-blockers.
Increased blood pressure, bradycardia, or heart block may occur due to excessive alpha-adrenergic receptor stimulation. In particular, amphetamines can inhibit the antihypertensive response to guanadrel, an adrenergic antagonist that causes depletion of norepinephrine in the synapse.
Moderate The risk of developing severe hypokalemia can be increased when amphotericin B is coadministered with thiazide diuretics. Monitoring serum potassium levels and cardiac function is advised, and potassium supplementation may be required. Amphotericin B liposomal LAmB: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects.
Major Most patients receiving the combination of two renin-angiotensin-aldosterone system RAAS inhibitors, such as angiotensin-converting enzyme inhibitors ACE inhibitors and angiotensin II receptor antagonists ARBs do not obtain any additional benefit compared to monotherapy.
In general, avoid combined use of these drugs together. Closely monitor blood pressure, renal function, and electrolytes. Combination therapy has been associated with an increased risk of diarrhea, hypotension, syncope, hyperkalemia, and renal dysfunction resulting in dialysis, doubling of serum creatinine, and death.
There was, however, a significantly increased rate of renal dysfunction associated with combination therapy Additionally, there was a significantly higher number of patients who discontinued therapy due to adverse reactions, including hypotensive symptoms 4. In a separate analysis of the ONTARGET renal outcomes, the rate of the composite primary renal outcome of dialysis, doubling of serum creatinine, and death was similar with ramipril and telmisartan alone Patients receiving concomitant therapy with ACE inhibitors and ARBs should be closely monitored for renal dysfunction, hypotension, and hyperkalemia.
Minor Coadministration of thiazides and antimuscarinics e. This is apparently a result of a decrease in gastrointestinal motility and rate of stomach emptying by the antimuscarinic agent. In addition, diuretics can increase urinary frequency, which may aggravate bladder symptoms. Extreme caution should be exercised if apomorphine is used concurrently with antihypertensive agents, or vasodilators such as nitrates. Minor Alpha blockers as a class may reduce heart rate and blood pressure.
While no specific drug interactions have been identified with systemic agents and apraclonidine during clinical trials, it is theoretically possible that additive blood pressure reductions could occur when apraclonidine is combined with the use of antihypertensive agents.
Patients using cardiovascular drugs concomitantly with apraclonidine should have their pulse and blood pressure monitored periodically. Minor Use caution if valsartan and aprepitant are used concurrently and monitor for a possible decrease in the efficacy of valsartan. After administration, fosaprepitant is rapidly converted to aprepitant and shares the same drug interactions.
The effects of aprepitant on tolbutamide were not considered significant. Minor Aripiprazole may enhance the hypotensive effects of antihypertensive agents. Major Avoid concomitant use of arsenic trioxide with thiazide diuretics.
Electrolyte abnormalities, such as hypokalemia and hypomagnesemia, may increase the risk for QT prolongation and torsade de pointes. Monitor electrocardiograms and serum electrolytes more frequently if concurrent use cannot be avoided. Moderate Sympathomimetics can antagonize the effects of antihypertensives such as metolazone when administered concomitantly.
Moderate Secondary to alpha-blockade, asenapine can produce vasodilation that may result in additive effects during concurrent use of antihypertensive agents. The potential reduction in blood pressure can precipitate orthostatic hypotension and associated dizziness, tachycardia, and syncope. If concurrent use of asenapine and antihypertensive agents is necessary, patients should be counseled on measures to prevent orthostatic hypotension, such as sitting on the edge of the bed for several minutes prior to standing in the morning and rising slowly from a seated position.
Close monitoring of blood pressure is recommended until the full effects of the combination therapy are known. Moderate Concurrent use of atazanavir with valsartan may result in elevated valsartan serum concentrations. Monitor for increased toxicities if these drugs are given together. Minor Caution is warranted when cobicistat is administered with valsartan as there is a potential for increased valsartan concentrations. Cobicistat is an inhibitor of OATP.
Moderate Concomitant administration of hydrochlorothiazide to patients receiving nondepolarizing neuromuscular blockers e.
Serum potassium concentrations should be determined and corrected if necessary prior to initiation of neuromuscular blockade therapy. Major Thiazide diuretics may cause the urine to become alkaline. This may reduce the effectiveness of methenamine by inhibiting its conversion to formaldehyde. Atropine; Hyoscyamine; Phenobarbital; Scopolamine: Moderate Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents.
This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. Moderate Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Moderate Barbiturates may potentiate orthostatic hypotension when used concurrently with thiazide diuretics. Belladonna Alkaloids; Ergotamine; Phenobarbital: Moderate Benzphetamine can increase both systolic and diastolic blood pressure and may counteract the activity of angiotensin II receptor antagonists.
This represents a pharmacodynamic, and not a pharmacokinetic, interaction. Close monitoring of blood pressure, especially in patients who are taking antihypertensive agents, may be needed. Moderate Patients on antihypertensive agents receiving bortezomib treatment may require close monitoring of their blood pressure and dosage adjustment of their medication. During clinical trials of bortezomib, hypotension was reported in roughly 12 percent of patients.
Moderate Although no specific interactions have been documented, bosentan has vasodilatory effects and may contribute additive hypotensive effects when given with angiotensin II receptor antagonists. Losartan has no effect on plasma concentrations of bosentan. However, bosentan may theoretically induce the metabolism of losartan via CYP2C9 isoenzymes clinical significance unknown. Moderate Although no specific interactions have been documented, bosentan has vasodilatory effects and may contribute additive hypotensive effects when given with diuretics.
Moderate Due to brexpiprazole's antagonism at alpha 1-adrenergic receptors, the drug may enhance the hypotensive effects of alpha-blockers and other antihypertensive agents. Minor Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
Moderate Concomitant use of medicines with potential to alter renal perfusion or function such as angiotensin II receptor antagonists, may increase the risk of acute phosphate nephropathy in patients taking sodium phosphate monobasic monohydrate; sodium phosphate dibasic anhydrous.
Moderate Concomitant use of medicines with potential to alter renal perfusion or function such as diuretics, may increase the risk of acute phosphate nephropathy in patients taking sodium phosphate monobasic monohydrate; sodium phosphate dibasic anhydrous. Moderate The simultaneous administration of thiazide diuretics and calcium salts or calcium carbonate may lead to hypercalcemia.
Thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium salts are used concomitantly, careful monitoring of serum calcium in recommended. Moderate When canagliflozin is initiated in patients already receiving diuretics, symptomatic hypotension can occur.
Before initiating canagliflozin in patients with one or more of these characteristics, volume status should be assessed and corrected. Monitor for signs and symptoms after initiating therapy. In addition, thiazide diuretics, can also decrease the hypoglycemic effects of antidiabetic agents by producing an increase in blood glucose concentrations.
Thiazide diuretics reduce the risk of stroke and cardiovascular disease in patients with diabetes. However, patients receiving canagliflozin should be monitored for changes in blood glucose control if such diuretics are added or deleted. Moderate Use caution if coadministration of capecitabine with valsartan is necessary, and monitor for an increase in valsartan-related adverse reactions. Moderate Both thiazide diuretics and carbamazepine are associated with hyponatremia. Coadministration may result in an additive risk of developing hyponatremia.
When concurrent therapy with a thiazide diuretic and carbamazepine is necessary, monitor patients for hyponatremia. Moderate Concomitant use of antihypertensive agents with levodopa can result in additive hypotensive effects. Moderate Thiazide diuretics can cause hypokalemia, hypomagnesemia, or hypercalcemia which may increase digoxin's pharmacologic effect.
Close monitoring of serum digoxin concentrations is essential to avoid enhanced toxicity. It is also recommended that serum potassium, magnesium, and calcium be monitored regularly in patients receiving digoxin. Moderate Orthostatic vital signs should be monitored in patients who are at risk for hypotension, such as those receiving cariprazine in combination with antihypertensive agents. Atypical antipsychotics may cause orthostatic hypotension and syncope, most commonly during treatment initiation and dosage increases.
Patients should be informed about measures to prevent orthostatic hypotension, such as sitting on the edge of the bed for several minutes prior to standing in the morning, or rising slowly from a seated position.
Consider a cariprazine dose reduction if hypotension occurs. NSAIDS have been associated with an inhibition of prostaglandin synthesis, which may result in reduced renal blood flow leading to renal insufficiency and increases in blood pressure that are often accompanied by peripheral edema and weight gain.
If an NSAID and a diuretic are used concurrently, carefully monitor the patient for signs and symptoms of decreased renal function and diuretic efficacy. Moderate Local anesthetics may cause additive hypotension in combination with antihypertensive agents. Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine: Although the manufacturer for Questran recommends that other medicines be taken at least 1 hour before or hours after cholestyramine, it has been recommended that thiazides be administered at least 4 hours before or after cholestyramine to minimize the reduction in absorption.
Severe The administration of cidofovir with another potentially nephrotoxic agent, such as diuretics, is contraindicated. Diuretics should be discontinued at least 7 days prior to beginning cidofovir. Major Cisapride should be used with great caution in patients receiving thiazide diuretics. Drugs that are associated with depletion of electrolytes may cause cisapride-induced cardiac arrhythmias. Serum electrolytes and creatinine should be assessed prior to administration of cisapride and whenever conditions develop that may affect electrolyte imbalance or renal function.
Moderate Citalopram causes dose-dependent QT interval prolongation. Concurrent use of citalopram and medications known to cause electrolyte imbalance may increase the risk of developing QT prolongation.
Therefore, caution is advisable during concurrent use of citalopram and diuretics. In addition, patients receiving a diuretic during treatment with citalopram may be at greater risk of developing syndrome of inappropriate antidiuretic hormone secretion SIADH. Hyponatremia may be potentiated by agents which can cause sodium depletion such as diuretics. Discontinuation of citalopram should be considered in patients who develop symptomatic hyponatremia.
Moderate A manufacturer of topical tretinoin states that tretinoin, ATRA should be administered with caution in patients who are also taking drugs known to be photosensitizers, such as thiazide diuretics, as concomitant use may augment phototoxicity.
Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. Therefore, monitor for signs of clofarabine toxicity such as gastrointestinal toxicity e. Thus, clopidogrel could increase plasma concentrations of drugs metabolized by this isoenzyme, such as valsartan. Although there are no in vivo data with which to predict the magnitude or clinical significance of this potential interaction, caution should be used when valsartan is coadministered with clopidogrel.
Major Caution is advisable during concurrent use of clozapine and thiazide diuretics. Clozapine used concomitantly with the antihypertensive agents can increase the risk and severity of hypotension by potentiating the effect of the antihypertensive drug. Treatment with clozapine has been associated with QT prolongation, torsade de pointes TdP , cardiac arrest, and sudden death.
Concurrent use of clozapine and medications known to cause electrolyte imbalance may increase the risk of QT prolongation. Moderate Clozapine used concomitantly with the antihypertensive agents can increase the risk and severity of hypotension by potentiating the effect of the antihypertensive drug. Cobicistat; Elvitegravir; Emtricitabine; Tenofovir Alafenamide: Moderate Caution is warranted when elvitegravir is administered with valsartan as there is a potential for decreased valsartan concentrations.
Moderate Fish oil supplements may cause mild, dose-dependent reductions in systolic or diastolic blood pressure in untreated hypertensive patients. Relatively high doses of fish oil are required to produce any blood pressure lowering effect.
Additive reductions in blood pressure may be seen when fish oils are used in a patient already taking antihypertensive agents. Moderate High doses of fish oil supplements may produce a blood pressure lowering effect. It is possible that additive reductions in blood pressure may be seen when fish oils are used in a patient already taking antihypertensive agents.
Moderate Co-enzyme Q10, ubiquinone CoQ10 may lower blood pressure. CoQ10 use in combination with antihypertensive agents may lead to additional reductions in blood pressure in some individuals.
Patients who choose to take CoQ10 concurrently with antihypertensive medications should receive periodic blood pressure monitoring. Patients should be advised to inform their prescriber of their use of CoQ Moderate Although to a lesser extent than cholestyramine, colestipol also has been shown to inhibit the GI absorption and therapeutic response of thiazide diuretics.
Administering thiazide diuretics at least 2 hours before colestipol has been suggested to minimize the interaction. Moderate There is potential for additive hypotensive effects when conivaptan is coadministered with antihypertensive agents. Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Moderate Use cosyntropin cautiously in patients receiving diuretics.
Cosyntropin may accentuate the electrolyte loss associated with diuretic therapy. Moderate Coadministration of thiazide diuretics and antineoplastic agents such as cyclophosphamide may result in reduced renal excretion of the antineoplastic agent and therefore increased myelosuppressive effects. Moderate Coadministration of cyclosporine and an angiotensin II receptor antagonist, like valsartan, may increase the risk of hyperkalemia and reduced renal function. In response to cyclosporine-induced renal afferent vasoconstriction and glomerular hypoperfusion, angiotensin II is required to maintain an adequate glomerular filtration rate.
Inhibition of angiotensin-converting enzyme ACE could reduce renal function acutely. Several cases of acute renal failure have been associated with the addition of enalapril to cyclosporine therapy in renal transplant patients.
Also, cyclosporine can cause hyperkalemia, and inhibition of angiotensin II leads to reduced aldosterone concentrations, which can increase the serum potassium concentration. Closely monitor renal function and serum potassium concentrations in patients receiving cyclosporine concurrently with valsartan.
You may take this medicine with or without food. This medicine comes with a patient information insert. Read and follow the instructions in the insert carefully. Ask your doctor if you have any questions.
Dosing TOP The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. For oral dosage form tablets: Adults—One tablet once a day.
© Copyright 2017 Valsartan 320 12.5mg. HOW SUPPLIED. Diovan HCT/Valsartan, Hydrochlorothiazide Oral Tab: mg, mg, mg, mg, mg..