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Hydrochlorothiazide / valsartan Side Effects

Medically reviewed by Last updated on Jul 8, 2023.

Applies to hydrochlorothiazide / valsartan: oral tablet.


Oral route (Tablet)

Drugs with direct action on the renin-angiotensin system can cause injury or death to the developing fetus. Discontinue valsartan/hydrochlorothiazide therapy as soon as possible when pregnancy occurs.

Serious side effects

Along with its needed effects, hydrochlorothiazide / valsartan may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking hydrochlorothiazide / valsartan:

Less common


Incidence not known

Other side effects

Some side effects of hydrochlorothiazide / valsartan may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common


Incidence not known

For Healthcare Professionals

Applies to hydrochlorothiazide / valsartan: oral tablet.

Nervous system

Common (1% to 10%): Headache, fatigue, dizziness

Rare (less than 0.1%): Vertigo, tinnitus[Ref]


Rare (less than 0.1%): Nausea, diarrhea, rash, acute pulmonary edema, interstitial nephritis or cystitis, anaphylaxis[Ref]

Rare cases of interstitial nephritis have been associated with the use of HCTZ. Although HCTZ has been used to treat nephrogenic diabetes insipidus, a case report in which the drug was believed to have caused this condition has been reported.[Ref]


Rare (less than 0.1%): Renal insufficiency, azotemia[Ref]

In multiple-dose studies in hypertensive patients with stable renal insufficiency and renovascular hypertension, the use of valsartan alone had no clinically significant effects of glomerular filtrate rate, filtration fraction, creatinine clearance, or renal plasma flow. The use of HCTZ has been associated with the development of pre-renal azotemia. Pretreatment volume repletion is recommended prior to initiating therapy.[Ref]


Rare (less than 0.1%): Palpitations, chest pain, angioedema

Frequency not reported: Cardiac arrhythmias (including ventricular ectopy and complete AV heart block)[Ref]

Chest pain was reported in more than 2% of patients who were taking this combination drug in controlled trials, but this incidence was not significantly different compared with the incidence of chest pain among placebo patients.[Ref]


Common (1% to 10%): Cough (valsartan component)

Uncommon (0.1% to 1%): Dyspnea, acute pulmonary edema[Ref]

Angiotensin II receptor blockade, unlike ACE inhibition, has no impact on the processing of peptides such as bradykinin and substance P, two peptides able to induce cough.

Bronchospasm, dyspnea, and epistaxis have rarely been associated with the use of this drug.[Ref]


Frequency not reported: Erythema annular centrifugum, acute eczematous dermatitis, morbilliform, leukocytoclastic vasculitis, phototoxic dermatitis, subacute cutaneous lupus erythematosus-like condition, pruritus, rash[Ref]


Rare (0.01% to 0.1%): Hypokalemia, hyperkalemia, metabolic alkalosis, hyponatremia, hypomagnesemia, hypercalcemia, hyperglycemia, elevated serum uric acid levels, elevated serum cholesterol[Ref]

Since HCTZ may increase total serum cholesterol by 11%, LDL lipoprotein cholesterol by 12%, and VLDL lipoprotein cholesterol levels by 50%, and may reduce insulin secretion, it should be used with caution in diabetic patients and in those with hypercholesterolemia. True glucose intolerance may develop in approximately 3% of patients. It is typically reversible within six months after discontinuation of therapy.

Hyperuricemia may be an important consideration in patients with a history of gout. Hypophosphatemia and low serum magnesium concentrations may occur, but are usually clinically insignificant except in malnourished patients.[Ref]


Thiazide diuretics may increase serum cholesterol and triglycerides, resulting in an increased risk of cholesterol gallstone formation. Reports of bowel strictures associated with thiazide ingestion were reported in the 1960s (although patients in these reports were on a combination HCTZ-potassium product).[Ref]

Uncommon (0.1% to 1%): Diarrhea, constipation, appetite changes, dry mouth, dyspepsia, nausea, vomiting, flatulence, pancreatitis, cholecystitis[Ref]


Rare (0.01% to 0.1%): Allergic vasculitis, hemolytic anemia[Ref]


Frequency not reported: Glucose intolerance, altered lipid profile[Ref]

Use of valsartan alone has not been associated with significant changes in serum lipids or glucose concentrations. However, use of HCTZ may be associated with increases in total serum cholesterol by 11%, LDL lipoprotein cholesterol by 12%, and VLDL lipoprotein cholesterol levels by 50%. In addition, use of HCTZ may be associated with reduced insulin secretion. Therefore, caution is recommended when giving this combination drug to diabetic patients or those with hypercholesterolemia.

Hyperuricemia may be an important consideration in patients with a history of gout. Hypophosphatemia and low serum magnesium concentrations may occur, but are usually clinically insignificant except in malnourished patients.

A prospective study of 34 patients who received oral thiazide diuretics for 14 years without interruption revealed significantly increased average fasting blood glucose levels. Withdrawal of thiazide therapy for 7 months in 10 of the patients resulted in average reductions of 10% in fasting blood glucose and 25% in 2-hour glucose tolerance test values. A control group was not reported.[Ref]


Common (1% to 10%): Back pain, muscle cramps, myalgia


Postmarketing reports: Rhabdomyolysis[Ref]


Common (1% to 10%): Neutropenia

Uncommon (0.1% to 1%): Hematocrit decreased, hemoglobin decreased

Rare (0.01% to 0.1%): Immune complex hemolytic anemia

Postmarketing reports: Thrombocytopenia[Ref]


Rare (less than 0.1%): Anxiety, depression, decreased libido, insomnia, paresthesias, somnolence[Ref]


Rare (less than 0.1%): Impotence, dysuria[Ref]


Uncommon (0.1% to 1%): Increases in hepatic enzymes (usually reversible)[Ref]


Rare (less than 0.1%): Abnormal vision, idiosyncratic reactions to hydrochlorothiazide resulting in acute transient myopia and acute angle-closure glaucoma[Ref]


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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.