From the Guidelines
Valsartan can occasionally cause increases in liver enzymes like AST and ALT, though this is relatively uncommon, and most patients taking valsartan do not experience significant liver enzyme elevations. When increases do occur, they are typically mild and transient, often resolving even with continued use of the medication. If you've recently started valsartan and noticed elevated liver enzymes, it's essential to consult with your healthcare provider before making any changes to your medication regimen. They may recommend monitoring your liver function tests over time to determine if the elevation is related to valsartan or has another cause. In rare cases where enzyme elevations are significant (greater than 3 times the upper limit of normal) or accompanied by symptoms like fatigue, nausea, abdominal pain, dark urine, or yellowing of the skin/eyes, your doctor might consider switching to an alternative medication, as seen in the management of other medications like tolvaptan 1. The mechanism behind valsartan's occasional effect on liver enzymes isn't fully understood but may relate to how angiotensin II receptor blockers affect liver metabolism.
Some key points to consider when evaluating the potential for valsartan to cause liver enzyme elevations include:
- The frequency and severity of liver enzyme elevations with valsartan are not as well-documented as with some other medications, such as tolvaptan 1.
- Monitoring of liver function tests is crucial in patients taking valsartan, especially if they have pre-existing liver disease or are taking other medications that can affect the liver.
- The decision to continue or discontinue valsartan in the face of liver enzyme elevations should be made on a case-by-case basis, taking into account the potential benefits and risks of the medication, as well as the presence of any symptoms or other laboratory abnormalities.
It's also important to note that while the provided evidence does not directly address the question of valsartan's effect on liver enzymes, the information available suggests that angiotensin II receptor blockers like valsartan can occasionally cause liver enzyme elevations, and that monitoring and careful management are essential to minimize the risk of adverse effects 1.
From the Research
Initiation of Valsartan and Liver Enzymes
- The initiation of Valsartan may cause an increase in AST and ALT levels, as observed in some studies 2, 3.
- A study published in the Journal of Korean Medical Science found that approximately 2% of patients receiving ARB therapy, including Valsartan, had significant ALT elevation 2.
- Another study published in the World Journal of Gastroenterology found that treatment with Valsartan or Telmisartan for 20 months resulted in a significant decrease in ALT levels in patients with non-alcoholic steatohepatitis (NASH) 3.
- However, the study also found that the decrease in ALT levels did not differ significantly between the Valsartan and Telmisartan groups 3.
Pharmacokinetics of Valsartan
- Valsartan is eliminated mainly by hepatic clearance, and its pharmacokinetics may be affected in patients with liver disease 4.
- A study published in Clinical Pharmacology and Therapeutics found that the mean exposure to Valsartan was increased about twofold in patients with mild and moderate liver impairment compared to healthy volunteers 4.
Cardiovascular Mortality and Liver Enzymes
- Elevated liver enzymes, including AST and ALT, have been associated with an increased risk of cardiovascular mortality 5.
- A systematic review and dose-response meta-analysis published in the European Journal of Gastroenterology and Hepatology found a direct association between baseline levels of ALP and AST/ALT ratio with CVD mortality 5.
- However, the study did not find a significant association between AST and the risk of CVD mortality 5.