Valsartan and hair loss is a concern raised by some patients taking this widely prescribed angiotensin II receptor blocker (ARB). Used across the UK for hypertension, heart failure, and post-myocardial infarction management, valsartan is generally well tolerated — but alopecia does appear in its product safety information. Understanding whether valsartan is truly responsible for hair changes, how common this side effect is, and what steps to take if you notice hair thinning are important questions for both patients and clinicians. This article reviews the available evidence, explores alternative causes, and outlines UK-specific guidance on investigation and management.

Valsartan and Hair Loss: What the Evidence Shows

Alopecia is listed as a rare or frequency-unknown adverse effect in valsartan's UK product information, but a causal relationship has not been firmly established in large-scale clinical trials — evidence is largely based on post-marketing surveillance and case reports.

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Valsartan is an angiotensin II receptor blocker (ARB) widely prescribed in the UK for conditions including hypertension, heart failure, and post-myocardial infarction management. It works by blocking the action of angiotensin II at the AT1 receptor, causing blood vessels to relax and reducing the workload on the heart. As with any medicine, patients sometimes report side effects that may or may not be directly attributable to the drug itself.

Hair loss (alopecia) is listed as an adverse effect in the Summary of Product Characteristics (SmPC) for valsartan-containing products available in the UK. The frequency classification varies across individual product SmPCs — some list alopecia as 'rare' (defined as affecting between 1 in 10,000 and fewer than 1 in 1,000 people) and others list it as 'not known' (meaning frequency cannot be estimated from available data). Patients and clinicians should refer to the SmPC for their specific product, available via the Electronic Medicines Compendium (EMC) or the MHRA website. The European Medicines Agency (EMA) and the MHRA have received spontaneous reports of alopecia associated with valsartan through post-marketing surveillance, though the overall volume of such reports remains low relative to the number of patients taking the medicine. The MHRA's Yellow Card Drug Analysis Profiles and EudraVigilance provide further context on the volume of these reports.

It is important to note that a causal relationship between valsartan and hair loss has not been firmly established in large-scale clinical trials. The evidence is largely based on post-marketing surveillance and individual case reports. This means that while a temporal association may exist for some patients — where hair loss begins after starting valsartan — this does not confirm that the medicine is the direct cause. Clinicians and patients should interpret this information carefully and avoid drawing firm conclusions without a thorough clinical assessment.

How Common Is Hair Loss With Antihypertensive Medicines?

Hair loss is uncommon across antihypertensive drug classes; beta-blockers have a more established association with telogen effluvium, while alopecia with ARBs such as valsartan is classified as rare or frequency unknown based on post-marketing data.

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Hair loss is not a widely recognised or frequently reported side effect across the antihypertensive drug class as a whole, but it has been noted — to varying degrees — with several different types of blood pressure medicines. Among ARBs, which include drugs such as losartan, candesartan, and irbesartan in addition to valsartan, alopecia appears in product information as a rare or frequency-unknown adverse effect for some agents (see individual SmPCs via the EMC).

Beta-blockers, another commonly used antihypertensive class, have a somewhat more established association with hair loss. Medicines used in UK practice such as bisoprolol, atenolol, and propranolol have been associated with a type of hair loss known as telogen effluvium (see BNF adverse effect listings and individual SmPCs). In medication-induced telogen effluvium, the pharmacological effect of the drug causes hair follicles to shift prematurely into the resting (telogen) phase, leading to diffuse shedding typically two to three months after the trigger. Importantly, this type of hair loss is generally reversible, with regrowth often occurring within three to six months of removing the causative agent. ACE inhibitors, such as ramipril and lisinopril, have also been occasionally associated with hair thinning, though again the evidence base is limited and largely derived from post-marketing reports.

For patients taking valsartan specifically, it is worth considering that:

• Medication-induced telogen effluvium may occur due to the pharmacological effect of the drug on hair follicle cycling, with onset typically two to three months after starting treatment

• Hormonal and metabolic changes associated with cardiovascular disease itself may contribute to hair changes independently of treatment

• Polypharmacy is common in this patient group, making it difficult to attribute hair loss to a single agent

Overall, hair loss attributable to antihypertensive medicines is considered uncommon, and most patients taking valsartan will not experience this side effect. The evidence across all antihypertensive classes is largely limited to case reports and post-marketing data rather than controlled clinical trials.

Other Possible Causes of Hair Loss to Consider

Androgenetic alopecia, thyroid disorders, and iron deficiency are among the most common causes of hair loss and should be excluded before attributing alopecia to valsartan, guided by NICE CKS and PCDS recommendations.

Before attributing hair loss to valsartan, it is essential to consider the wide range of other conditions and factors that commonly cause alopecia. Many patients prescribed valsartan are middle-aged or older adults who may be at increased risk of hair loss for entirely unrelated reasons.

Common alternative causes include:

• Androgenetic alopecia (male or female pattern hair loss) — the most prevalent cause of hair loss in adults, driven by genetic and hormonal factors; see NICE CKS guidance on male and female pattern hair loss

• Thyroid disorders — both hypothyroidism and hyperthyroidism can cause diffuse hair thinning; thyroid function testing (TSH) is recommended as part of the initial investigation of unexplained diffuse hair loss where clinically indicated, in line with NICE CKS and PCDS guidance

• Iron deficiency — a frequently overlooked cause, particularly in women; a full blood count and serum ferritin level are standard first-line investigations in UK primary care

• Telogen effluvium — triggered by physical or emotional stress, significant illness, surgery, or rapid weight loss, typically occurring two to three months after the precipitating event, with spontaneous recovery expected within three to six months

• Alopecia areata — an autoimmune condition causing patchy hair loss; see NICE CKS guidance

• Nutritional deficiencies — deficiencies in iron and zinc may contribute; biotin deficiency is rare in the UK. Testing for vitamin D, zinc, and biotin is not recommended routinely and should only be undertaken where there is a specific clinical indication based on history and examination, in line with NICE CKS and PCDS guidance

It is also worth noting that cardiovascular disease and associated metabolic conditions may be independently linked to hair changes, though the evidence for this is limited. This makes it particularly challenging to isolate the contribution of any single medicine in this patient population. A thorough medical history, examination, and targeted blood tests — guided by clinical findings — are therefore important steps before concluding that valsartan is responsible for hair changes. The NHS provides patient-facing information on common causes of hair loss at nhs.uk.

What to Do If You Notice Hair Loss While Taking Valsartan

Speak to your GP rather than stopping valsartan abruptly; first-line investigations include full blood count, serum ferritin, and thyroid function tests, with a possible switch to an alternative antihypertensive if no other cause is found.

If you notice increased hair shedding or thinning after starting valsartan, it is advisable to speak to your GP or prescribing clinician rather than stopping the medicine abruptly. Valsartan is often prescribed for important cardiovascular indications, and discontinuing it without medical supervision could carry risks to your heart health or blood pressure control.

Your GP will typically begin by taking a detailed history to establish the timeline of hair loss in relation to when valsartan was started, and to identify any other potential contributing factors. In line with NICE CKS and PCDS guidance, first-line investigations in UK primary care commonly include:

• Full blood count (to check for anaemia)

• Serum ferritin (to assess iron stores)

• Thyroid function tests (TSH)

Additional tests — such as blood glucose, HbA1c, vitamin D, or zinc levels — should only be arranged if there are specific clinical features suggesting these as contributing causes, rather than as a routine panel.

Red flags that warrant prompt or urgent referral to a dermatologist include:

• Scarring alopecia or significant scalp inflammation

• Rapid or progressive hair loss

• Patchy hair loss with associated systemic symptoms

• Diagnostic uncertainty after initial assessment

If investigations reveal an underlying cause, this should be treated appropriately. If no alternative cause is found and there is a strong temporal association with valsartan, your doctor may consider switching to an alternative antihypertensive agent, guided by NICE NG136 (Hypertension in adults) and any relevant comorbidity-specific recommendations. Suitable alternatives may include an ACE inhibitor, a calcium channel blocker, or a thiazide-like diuretic, depending on your individual clinical circumstances. Any such change should be made under medical supervision with appropriate monitoring of blood pressure.

If medication-induced telogen effluvium is suspected, it is worth noting that hair loss of this type is generally reversible, with regrowth typically expected within three to six months of removing the causative trigger.

Do not stop taking valsartan without speaking to a healthcare professional first. In most cases, the benefit of blood pressure control outweighs the risk of a rare and often reversible side effect. Referral to a dermatologist may be appropriate if hair loss is severe, progressive, or does not resolve after addressing potential causes, in line with NICE CKS and PCDS referral criteria.

MHRA Guidance and Reporting Side Effects in the UK

Hair loss associated with valsartan can be reported to the MHRA via the Yellow Card scheme; the 2018 nitrosamine contamination recall affecting some valsartan products was entirely unrelated to alopecia and has since been resolved.

The MHRA is the UK regulatory authority responsible for monitoring the safety of medicines after they have been licensed. Post-marketing surveillance — the ongoing monitoring of medicines once they are in widespread use — plays a crucial role in identifying rare side effects that may not have been apparent during clinical trials. Hair loss associated with valsartan has been captured through this surveillance process, which is why it appears in the product's safety information despite limited evidence from controlled studies.

In the UK, both healthcare professionals and patients can report suspected side effects directly to the MHRA through the Yellow Card scheme (yellowcard.mhra.gov.uk). The MHRA also publishes Drug Analysis Profiles, which provide a summary of Yellow Card reports received for individual medicines and are accessible via the Yellow Card interactive data dashboard. Reporting is encouraged even when you are not certain that the medicine caused the side effect — the scheme is designed to detect signals and patterns across large numbers of reports. Submitting a Yellow Card report for hair loss while taking valsartan contributes to the collective evidence base and helps regulators make informed decisions about medicine safety.

It is worth noting that in 2018, a separate and significant safety issue arose with certain valsartan-containing products manufactured by specific suppliers, which were found to contain nitrosamine impurities (N-nitrosodimethylamine, NDMA). The MHRA issued a recall of affected batches and published communications on this issue at the time. This contamination issue is entirely unrelated to hair loss and has since been addressed through tightened manufacturing standards and regulatory requirements. Patients who have concerns about their specific product can check the MHRA website or speak to their pharmacist.

If you are concerned about any side effect from valsartan or any other medicine, the NHS recommends contacting your GP, pharmacist, or calling NHS 111 for guidance. Always carry an up-to-date medicines list to appointments to support accurate clinical review.

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