Can Valsartan Cause Chills?
Chills are not a recognized or documented adverse effect of valsartan based on extensive clinical trial data and guideline evidence. The well-established side effects of valsartan include dizziness, headache, hypotension, hyperkalemia, and renal dysfunction, but chills are notably absent from this profile 1, 2, 3.
Evidence-Based Side Effect Profile
The safety profile of valsartan has been extensively characterized across multiple large-scale trials and systematic reviews:
Common adverse effects documented in clinical trials include dizziness, headache, and cough (though cough occurs significantly less frequently than with ACE inhibitors) 1, 2.
Serious adverse effects requiring monitoring include hypotension, hyperkalemia, and worsening renal function, particularly when combined with other renin-angiotensin-aldosterone system inhibitors 4.
Tolerability profile is comparable to placebo in the majority of hypertension studies, with ARBs demonstrating significantly fewer side effects than ACE inhibitors 4, 5, 3.
Rare cutaneous reactions have been reported in isolated case reports, including exanthematous drug eruptions with erythematous maculopapular rash, but these present as skin manifestations rather than systemic symptoms like chills 6.
Photosensitivity Consideration
One documented effect that could theoretically be confused with chills is photosensitivity:
Valsartan is listed among ARBs that can cause drug-induced photosensitivity reactions, which may include exaggerated sunburn reactions 4.
However, photosensitivity reactions manifest as skin changes (erythema, dermatitis) rather than systemic chills 4.
Alternative Explanations to Consider
If a patient on valsartan reports chills, investigate these more likely causes:
Infection or inflammatory process unrelated to the medication, particularly if accompanied by fever or other systemic symptoms.
Hypotension-related symptoms: While valsartan can cause symptomatic hypotension (especially when combined with sacubitril), this typically presents as dizziness or lightheadedness rather than chills 7.
Concurrent medications: Review all medications for potential drug interactions or side effects from other agents.
Underlying cardiovascular disease progression: In patients with heart failure or post-MI status, new symptoms warrant evaluation for disease progression rather than medication side effects 4.
Clinical Monitoring Priorities
When managing patients on valsartan, focus monitoring on documented adverse effects rather than chills:
Blood pressure monitoring for hypotension, particularly within 1-2 weeks after initiation or dose changes 4.
Renal function and potassium levels should be checked at 1,2,3, and 6 months after achieving maintenance dose, then every 6 months 4.
Dose adjustment is required if creatinine rises above 220 μmol/L (2.5 mg/dL) or potassium exceeds 5.5 mmol/L 4.