Valsartan vs. Losartan: Similarities & Differences
Medically reviewed by Femi Aremu, PharmD
Hypertension (HBP, high blood pressure) is a common medical condition affecting 48% of adult Americans. Left untreated, high blood pressure can lead to potentially severe health complications, including heart problems, stroke, and kidney disease.
Fortunately, safe and effective pharmaceutical treatment options for high blood pressure do exist. Examples include valsartan, whose brand name is Diovan, and losartan, whose brand name is Cozaar.
Valsartan and losartan are orally administered prescription medications used to treat high blood pressure and other conditions, such as heart failure (HF) or left ventricular hypertrophy (LVH).
Valsartan and Cozaar are classified as angiotensin receptor blockers (ARBs).
While generally viewed as similar, these drugs share notable differences. Examples include differences in their respective onset of action, Food and Drug Administration (FDA)–approved uses, potential side effects, and differences in dosing volume.
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Understanding High Blood Pressure
Blood pressure is the force of blood that pushes against the walls of the arteries. Arteries carry blood from the heart to various parts of the body.
While blood pressure can fluctuate throughout the day, it can cause heart problems and other health complications if it stays high consistently.
Specifically, high blood pressure is defined as pressure greater than 140/90 millimeters of mercury (mm Hg).
Causes
High blood pressure, which usually develops over some time, can be caused by certain health conditions, such as diabetes, obesity, or pregnancy; lifestyle factors, such as a sedentary lifestyle; or other factors, such as ongoing stress.
Treatment Options
If you have high blood pressure, your healthcare provider may recommend lifestyle changes, possibly in combination with prescription medication.
Examples of lifestyle changes include:
Following a heart-healthy eating plant such as the DASH diet (Dietary Approaches to Stop Hypertension)
Getting regular physical activity (check with your healthcare provider before beginning a new exercise program)
Targeting a healthy weight
Achieving enough high-quality sleep
Various medications manage high blood pressure, including angiotensin-converting enzyme (ACE) inhibitors. beta-blockers, and calcium channel blockers (CCBs).
This article will focus on two ARBs, valsartan and losartan.
What Are ARBs?
As ARBs, valsartan and losartan achieve therapeutic by working on a system in the body called the renin-angiotensin system (RAS), a group of hormones that regulate blood pressure and control inflammation.
More specifically, ARBs can help manage high blood pressure by doing the following:
Angiotensin 2 (AT2) is a hormone the body makes that helps regulate blood pressure.
AT2 narrows blood vessels, especially in the kidneys. Too much AT2 causes the blood vessels in the kidneys to be unable to relax, causing high blood pressure. It can also cause kidney damage and worsen heart problems.
For AT2 to increase blood pressure, it must act on receptors in the body. Think of it like a lock and key. AT2 is the key, and for it to raise blood pressure, it must fit into the lock.
ARB medications block the receptors (locks) so that AT2 (the key) cannot fit. This helps slow down how much AT2 is made in the body.
The result is less AT2, which helps keep blood vessels relaxed and lowers pressure in the kidneys and throughout the body.
What Is Valsartan?
Valsartan is an orally administered ARB.
Both brand-name Diovan and generic forms of valsartan come in oral tablets and a liquid suspension.
Uses
Valsartan is FDA-approved to:
Treat high blood pressure in adults and children 1 year and older. Lowering blood pressure lowers the risk of strokes and heart attacks, which can cause death.
Treat HF in adults to lower the risk of hospitalization.
Lower the risk of death after a heart attack in adults with LVH or left ventricular dysfunction (problems with the left ventricle of the heart that cause the heart not to pump blood efficiently).
Off-Label Uses
Sometimes, healthcare providers prescribe a medication for use or at a dosage for which the FDA did not initially approve. This is called off-label prescribing.
Healthcare providers may prescribe valsartan off-label to:
Protect the kidneys in people with kidney disease
Treat cardiovascular autonomic neuropathy, a severe complication of diabetes that affects the heart and blood vessels
Valsartan in Other Products
Valsartan is also available as an ingredient in several combination drugs, including the following:
Diovan HCT: A combination medication that contains valsartan plus a diuretic (water pill) called hydrochlorothiazide (HCTZ), which is used to treat high blood pressure
Entresto: A combination medication that contains sacubitril and valsartan to treat HF
Exforge: A combination medication that contains amlodipine and valsartan is used to treat high blood pressure
Exforge HCT: A combination medication that contains amlodipine, valsartan, and HCTZ to treat high blood pressure
What Is Losartan?
Both generic losartan and brand-name Cozaar are available as oral tablets.
Losartan is FDA-approved to:
Treat high blood pressure in adults and children 6 years and older
Lower the risk of stroke in people who have both high blood pressure and LVH (this benefit may not apply to Black individuals)
Treat diabetic nephropathy (kidney problems associated with diabetes) in people with type 2 diabetes and a history of high blood pressure
Off-Label Uses
Some examples of losartan off-label uses include:
Treatment of HF
Treatment of cardiovascular autonomic neuropathy
Losartan in Other Products
Losartan is an ingredient in combination drugs, including Hyzaar, which contains losartan and HCTZ, which helps with fluid retention.
This combination of medications treats high blood pressure and lowers the risk of stroke in people with high blood pressure and LVH.
Dosing Guidelines
General dosing guidelines for valsartan and losartan appear below. Your healthcare provider will select the proper prescription schedule and strength for you.
Valsartan Dosing
Valsartan is available as oral tablets in the following dosage forms:
40 milligrams (mg)
80 mg
160 mg
320 mg
Valsartan is also available as an oral solution containing 4 mg of valsartan per milliliter (mL) of liquid. The suspension is usually taken daily with or without food to treat high blood pressure.
Valsartan dosing guidelines for its tablet form are as follows:
For high blood pressure in adults, the starting dose is 80 or 160 mg once daily, and the maintenance dosing range is 80 to 320 mg once daily.
For high blood pressure in children and adolescents 1–16 years old, the dosage depends on weight, with a maximum starting dose of 40 mg daily and a maximum maintenance dose of 160 mg daily.
For HF in adults, the starting dose is 40 mg twice daily, and the maintenance dose is 40 to 160 mg twice daily.
To improve survival after a heart attack, the starting dose is 20 mg twice daily, and the maintenance dose is 20 to 160 mg twice daily.
Losartan Dosing
Losartan is available as oral tablets in the following dosage forms:
25 mg
50 mg
100 mg
General losartan dosing guidelines follow:
For high blood pressure in adults, the usual dose is 50 mg daily.
For high blood pressure in children and adolescents, the dose depends on weight, with a maximum daily dose of 50 mg.
For people with LVH and high blood pressure, the starting dose is 50 mg daily. If blood pressure response is insufficient, the healthcare provider may add HCTZ 12.5 mg and/or increase the losartan dose to 100 mg daily (in one or two divided doses).
For people with diabetic nephropathy, the usual dose is 50 mg once daily. However, if the blood pressure response is insufficient, the prescribing provider may increase the losartan dose to 100 mg daily (in one or two divided doses).
Comparing Efficacy
The guidelines for treating high blood pressure, known as the Eighth Joint National Committee (JNC 8), list some information about ARBs as follows:
ARBs, such as valsartan or losartan, are recommended as one of the first choices in treating high blood pressure, including people with diabetes in what was referred to as "the general non-black population." Conversely, guidelines state that in the general Black population, the first treatment choice should be a thiazide diuretic such as HCTZ or a CCB.
In adults with kidney problems, the first choice (or add-on) medication for high blood pressure should include an ARB or, conversely, an ACE inhibitor, which works on a different part of the RAS). This recommendation applies to people of any race, with or without diabetes.
Studies and Findings
Study results regarding efficacy include:
One study compared valsartan, losartan, and another ARB, Benicar (olmesartan). The researchers found that over 12 weeks, all three medications were similarly effective in lowering blood pressure.
One study found valsartan 160 or 320 mg daily to be better at lowering blood pressure than losartan 100 mg daily.
Some studies show that valsartan and losartan are similarly effective in lowering blood pressure in individuals with mild to moderate high blood pressure. Losartan (but not valsartan) also reduced uric acid levels. This could be a consideration because increased uric acid levels are associated with gout, kidney disease, and heart disease.
Because many considerations can factor into which drug is most appropriate for you, consult your healthcare provider for medical advice.
Side Effects & Safety
As with all drugs, Valsartan and losartan carry the potential for adverse effects. Therefore, be sure to closely monitor yourself or a loved one for the emergence of adverse effects.
Contact your healthcare provider immediately if you observe side effects that fail to dissipate or worsen.
And, if needed, call 911 if your symptoms feel life-threatening, or you think you or a loved one is experiencing a medical emergency.
Black Box Warning
All ARBs, including valsartan and losartan, have a black box warning, the most severe warning issued by the FDA.
The warning states that drugs that act on the RAS, like ARBs, can cause harm and death to the unborn baby. Pregnant individuals should never take an ARB.
If you already take an ARB and find out you are pregnant, you should stop the drug and consult your healthcare provider for medical advice.
Common Side Effects
Common side effects of valsartan include but are not limited to:
Stomach problems such as nausea, diarrhea, and stomach pain
Back and joint pain
Common side effects of losartan include but are not limited to:
Pain in the legs, knees, or back
Muscle cramps
Stomach problems, such as diarrhea or indigestion
Decreased sensitivity to touch
Severe Side Effects
In addition to the black box warning mentioned above, serious side effects of valsartan and losartan include the following:
Symptoms associated with anaphylaxis (life-threatening allergic reaction), such as urticaria (hives), difficulty breathing or swallowing, or swelling of the face, lips, tongue, or throat
Swelling of the hands, feet, ankles, or lower legs
Unexplained weight gain
Safe Use Guidelines
Valsartan and losartan are not appropriate for everyone.
Before taking valsartan or losartan, tell your healthcare provider about any:
Allergies to medications
Medical conditions
Medical history
Family history
You should not take valsartan or losartan if you are allergic to either of these medications, ARB, or inactive ingredients in valsartan or losartan.
Other people who should not take valsartan or losartan include:
People with diabetes who take the antihypertensive medication, Tekturna (aliskiren)
Pregnant individuals
Potential for Interaction
Tell your healthcare provider about all of the medicines you take, including:
Prescription medications
Over-the-counter (OTC) medicines
Vitamins
Supplements
While taking valsartan or losartan, do not start any new medications without approval from your healthcare provider.
Drug interactions can occur if using valsartan or losartan with the following medications:
Potassium-sparing diuretics, such as Aldactone (spironolactone), potassium supplements, or salt substitutes, may increase potassium levels when combined with valsartan and losartan.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) or Mobic (meloxicam), can increase the risk of kidney problems when used with valsartan and losartan. The combination can also affect how well the ARB works for lowering blood pressure, making it work ineffectively.
Valsartan or losartan should not be combined with any other medication affecting the RAS. This includes other ARBs and ACE inhibitors, such as Zestril (lisinopril) or Altace (ramipril). For context, know that people with diabetes or kidney problems will never be prescribed Tekturna (aliskiren), valsartan, or losartan.
The mood stabilizer medication, lithium, interacts with ARBs. When combined, lithium levels, as well as side effects, can increase.
This is not a complete list of drug interactions.
Other drug interactions may occur with valsartan or losartan. Consult your healthcare provider for more information about drug interactions and how they may affect you.
Summary
Valsartan (brand name Diovan) and losartan (brand name Cozaar) are two orally administered prescription medications in the angiotensin receptor blocker (ARB) drug class. They can administered to adults and children depending on need.
Valsartan and losartan are FDA-approved to treat high blood pressure and similar conditions, such as HF.
Furthermore, both drugs are deemed generally safe and effective by experts when used according to their prescribing information (PI) and under the supervision of a healthcare provider.
Yet, despite their similarities, they carry notable differences, such as discrepancies in their FDA-approved uses, off-label uses, potential side effects, dosing forms (tablets versus liquid forms of administration), and how quickly both drugs begin working.
Consult your healthcare provider for more information about valsartan and losartan.
Frequently Asked Questions
How do I store valsartan or losartan?
Store valsartan or losartan at room temperature (68–77 degrees F), away from direct light, heat, and moisture. Do not store medication in the bathroom or any area susceptible to high moisture levels.
As with all medications, keep out of sight and out of reach of children and pets. Keep the bottle tightly closed when not in use.
Can I take valsartan or losartan if I am pregnant?
No. These medications have a black box warning, the most severe warning issued by the FDA.
You should not take valsartan or losartan if you are pregnant because these medications could cause harm or death to the unborn baby.
If you already take valsartan or losartan and find out you are pregnant, stop taking the medication and consult with your healthcare provider.
Should I take valsartan or losartan with food?
You can take valsartan or losartan with or without food.
Read the original article on Verywell Health.
