Can Valsartan Cause Itchiness?
Yes, valsartan can cause itchiness, though it is not among the most common adverse reactions reported in clinical trials. 1
Evidence from FDA Drug Labeling
The FDA-approved prescribing information for valsartan does not list pruritus (itching) among the most frequent adverse reactions in the main clinical trial data tables. 1 However, the postmarketing surveillance section specifically documents that dermatologic reactions including alopecia and bullous dermatitis have been reported after market approval, indicating that skin-related adverse effects do occur with valsartan use, though their exact frequency cannot be reliably estimated. 1
Published Case Reports and Research Evidence
A documented case report from 2012 describes a 47-year-old man who developed diffuse, itchy erythematous maculopapular eruption after 10 days of valsartan 160 mg daily. 2 The eruption began on the third day of therapy as facial erythema and spread throughout the body within one week. 2 Histopathologic examination confirmed drug reaction features including lymphocyte exocytosis, spongiosis, necrotic keratinocytes, and perivascular eosinophils. 2
The authors of this case report emphasize that physicians should be aware of cutaneous side effects from angiotensin receptor blockers (ARBs), as there are relatively few reports about skin reactions compared to other antihypertensive drug classes (diuretics, beta-blockers, calcium-channel blockers, ACE inhibitors). 2
Context Within the ARB Drug Class
Valsartan is recognized in cardiovascular guidelines as having photosensitivity potential. A 2022 guideline on traveling with heart failure specifically lists valsartan among angiotensin receptor blockers (along with candesartan, irbesartan, losartan, olmesartan, and telmisartan) that are linked to drug-induced photosensitivity. 3 This suggests that skin reactions, including itching triggered by sun exposure, are a recognized class effect of ARBs including valsartan.
Comparison to ACE Inhibitors
Valsartan has a more favorable tolerability profile than ACE inhibitors, with significantly lower incidence of cough and only rare reports of angioedema. 4 In clinical trials comparing valsartan to captopril post-myocardial infarction, rash occurred in only 0.2% of valsartan-treated patients versus 0.6% of captopril-treated patients. 1 This suggests that while skin reactions can occur with valsartan, they are less frequent than with ACE inhibitors.
Clinical Recommendations
If a patient on valsartan develops itchiness, particularly if accompanied by visible rash, consider valsartan as a potential causative agent. 2
Obtain a detailed timeline of symptom onset relative to drug initiation (the documented case showed onset within 3-10 days of starting therapy). 2
Examine carefully for subtle skin changes including erythema, maculopapular eruption, or photosensitivity patterns, as itching may precede or accompany visible findings. 2, 3
If valsartan-induced skin reaction is suspected and the patient requires continued renin-angiotensin system blockade, consider switching to an ACE inhibitor (though note ACE inhibitors have their own skin reaction profile) or a different ARB, as cross-reactivity is not universal. 2
For patients with isolated itching without rash on valsartan, systematically exclude other common causes including iron deficiency, chronic kidney disease, cholestatic liver disease, other medications, and thyroid disorders before attributing symptoms to valsartan. 5