ents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise.
Nitrates: Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Dosage adjustments may be necessary.
Nitroglycerin: Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Dosage adjustments may be necessary.
Nitroprusside: Additive hypotensive effects may occur when nitroprusside is used concomitantly with other antihypertensive agents. Dosages should be adjusted carefully, according to blood pressure.
Nonsteroidal antiinflammatory drugs: Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible.
Obeticholic Acid: Obeticholic acid may increase the exposure to valsartan. Valsartan is a substrate of OATP1B1 and obeticholic acid inhibits OAT1B1 in vitro. Caution and close monitoring is advised if these drugs are used together.
Olanzapine: Olanzapine may induce orthostatic hypotension and thus enhance the effects of antihypertensive agents.
Olaparib: Use caution if coadministration of olaparib with valsartan is necessary, due to an increased risk of valsartan-related adverse reactions. Valsartan is a substrate of CYP2C9, OATP1B1, and MRP2. Olaparib is an in vitro OATP1B1 inhibitor, although the clinical relevance is unknown.
Ombitasvir; Paritaprevir; Ritonavir: Coadministration of valsartan and regimens containing paritaprevir may result in elevated valsartan plasma concentrations. A valsartan dose reduction, and close monitoring for adverse events (i.e., hypotension and worsening renal function) are advised during coadministration. If adverse events are observed, consider further reductions in valsartan dose or an alternative to the angiotensin receptor blocker. Valsartan is a substrate of the organic anion transporting polypeptides (OATP) and paritaprevir is an OATP1B1 and OATP1B3 inhibitor. Valsartan is a substrate of the hepatic efflux transporter MRP2 and ritonavir is an inhibitor of MRP2. Coadministration may increase systemic exposure to valsartan. Patients should be monitored for adverse effects of valsartan during coadministration.
Oritavancin: Valsartan is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated valsartan plasma concentrations. If these drugs are administered concurrently, blood pressure should be monitored closely.
Paliperidone: Paliperidone may cause orthostatic hypotension and thus enhance the hypotensive effects of antihypertensive agents. Lower initial doses of paliperidone may be necessary in patients receiving antihypertensive agents concomitantly.
Pentoxifylline: Pentoxifylline has been used concurrently with antihypertensive drugs |
