The ADRs reported from clinical studies, post-marketing experience and laboratory findings are listed as follows according to system organ class.
Adverse reactions are ranked by frequency, the most frequent first, using the following convention: Very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥ 1/1,000 to <1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000), including isolated reports. Within each frequency grouping, adverse reactions are ranked in order of decreasing seriousness.
For all the ADRs reported from post-marketing experience and laboratory findings, it is not possible to apply any ADR frequency and therefore they are mentioned with a "not known" frequency.
Adverse Drug Reactions in Hypertension: Blood and Lymphatic System Disorders: Not Known: Haemoglobin decreased, haematocrit decreased, neutropenia, thrombocytopenia.
Immune System Disorders: Not Known: Hypersensitivity including serum sickness.
Metabolism and Nutrition Disorders: Not Known: Blood potassium increased.
Ear and Labyrinth System Disorders: Uncommon: Vertigo.
Vascular Disorders: Not Known: Vasculitis.
Respiratory, Thoracic and Mediastinal Disorders: Uncommon: Cough.
Gastrointestinal Disorders: Uncommon: Abdominal pain.
Hepato-biliary Disorders: Not Known: Liver function test abnormal including blood bilirubin increase.
Skin and Subcutaneous Tissue Disorders: Not Known: Angioedema, dermatitis bullous, rash, pruritus.
Musculoskeletal and Connective Tissue Disorders: Not Known: Myalgia.
Renal and Urinary Disorders: Not Known: Renal failure and impairment, blood creatinine increased.
General Disorders and Administration Site Conditions: Uncommon: Fatigue.
The following events have also been observed during clinical trials in hypertensive patients irrespective of their causal association with the study drug: Arthralgia, asthenia, back pain, diarrhoea, dizziness, headache, insomnia, libido decrease, nausea, oedema, pharyngitis, rhinitis, sinusitis, upper respiratory tract infection, viral infections.
Hypertensive Adult Patients with Impaired Glucose Tolerance at Cardiovascular Risk: In the NAVIGATOR study, adverse events with valsartan were similar to those reported previously for patients with hypertension.
Paediatric Population (Hypertension): The antihypertensive effect of valsartan has been evaluated in two randomized, double-blind clinical studies in 561 pediatric patients from 6 to 18 years of age. No relevant differences in terms of type, frequency and severity of adverse reactions were identified between the safety profile for pediatric patients aged 6 to 18 years and that previously reported for adult patients.
Neurocognitive and developmental assessment of pediatric patients aged 6 to 16 years of age revealed no overall clinically relevant adverse impact after treatment with valsartan for up to one year.
In a double-blind randomized study in 90 children aged 1 to 6 years, which was followed by a one-year open-label extension, two deaths and isolated cases of marked liver transaminases elevations were observed. In a second study in which 75 children aged 1 to 6 years were randomized, no deaths and one case of marked liver transaminase elevations occurred during a one year open-label extension. These cases occurred in a population who has significant comorbidities. A causal relationship to valsartan has not been established.
Hypokalaemia has been observed in children and adolescents aged 6 to 18 years with underlying chronic kidney disease.
Heart Failure and/or Post-Myocardial Infarction: The safety profile seen in controlled-clinical studies in patients with heart failure and/or post-myocardial infarction varies from the overall safety profile seen in hypertensive patients. This may relate to the patients underlying disease. ADRs that occurred in heart failure and/or post-myocardial infarction patients are listed as follows.
Adverse Drug Reactions in Heart Failure and/or Post-Myocardial Infarction: Blood and Lymphatic System Disorders: Not Known: Thrombocytopenia.
Immune System Disorders: Not Known: Hypersensitivity including serum sickness.
Metabolism and Nutrition Disorders: Uncommon: Hyperkalemia.
Nervous System Disorders: Common: Dizziness, postural dizziness. Uncommon: Syncope, headache.
Ear and Labyrinth System Disorders: Uncommon: Vertigo.
Cardiac Disorders: Uncommon: Cardiac failure.
Vascular Disorders: Common: Hypotension, orthostatic hypotension. Not Known: Vasculitis.
Respiratory, Thoracic and Mediastinal Disorders: Uncommon: Cough.
Gastrointestinal Disorders: Uncommon: Nausea, diarrhea.
Hepato-biliary Disorders: Not Known: Liver function test abnormal.
Skin and Subcutaneous Tissue Disorders: Uncommon: Angioedema. Not Known: Dermatitis bullous, rash, pruritus.
Musculoskeletal and Connective Tissue Disorders: Not Known: Myalgia.
Renal and Urinary Disorders: Common: Renal failure and impairment. Uncommon: Acute renal failure, blood creatinine increased. Not Known: Blood urea increased.
General Disorders and Administration Site Conditions: Uncommon: Asthenia, fatigue.
Blood potassium increased (frequency unknown): reported in post market reporting.
The following events have also been observed during clinical trials in patients with heart failure and/or post-myocardial infarction irrespective of their causal association with the study drug: Arthralgia, abdominal pain, back pain, insomnia, libido decrease, neutropenia, oedema, pharyngitis, rhinitis, sinusitis, upper respiratory tract infection, viral infections.
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