From the Guidelines
Valsartan is typically started at a dose of 80 mg or 160 mg once daily for most adults with hypertension, and can be titrated upward to a maximum of 320 mg once daily, as recommended by the most recent guidelines 1.
Key Considerations
- For patients who are elderly, volume-depleted, or have renal impairment, a lower starting dose of 40 mg once daily is recommended.
- The dose can be titrated upward based on blood pressure response, usually at 2-4 week intervals.
- For heart failure, the starting dose is usually 40 mg twice daily, titrated up to a target of 160 mg twice daily as tolerated.
- For post-myocardial infarction, valsartan is initiated at 20 mg twice daily and increased to 40 mg twice daily within 7 days, with subsequent titration to 160 mg twice daily as tolerated.
Mechanism of Action
- Valsartan works by blocking angiotensin II receptors, causing vasodilation and reducing aldosterone secretion, which helps lower blood pressure.
Administration and Monitoring
- Valsartan can be taken with or without food, and consistent timing each day helps maintain steady blood levels.
- Patients should be monitored for hypotension, hyperkalemia, and changes in renal function, particularly when initiating therapy or increasing the dose.
Evidence-Based Recommendations
- The 2022 AHA/ACC/HFSA guideline for the management of heart failure recommends valsartan as a treatment option for heart failure with reduced ejection fraction (HFrEF) 1.
- The guideline also recommends titrating the dose of valsartan to a target of 160 mg twice daily, as tolerated, to achieve optimal clinical benefit.
From the FDA Drug Label
2.2 Adult Hypertension The recommended starting dose of valsartan tablet is 80 mg or 160 mg once daily when used as monotherapy in patients who are not volume-depleted. 2.3 Pediatric Hypertension 1 to 16 Years of Age The usual recommended starting dose is 1 mg/kg once daily (up to 40 mg total). 2.4 Heart Failure The recommended starting dose of valsartan tablet is 40 mg twice daily. 2.5 Post-Myocardial Infarction Valsartan tablets may be initiated as early as 12 hours after a myocardial infarction. The recommended starting dose of valsartan tablet is 20 mg twice daily.
The dosing of valsartan is as follows:
- Adult Hypertension: 80 mg or 160 mg once daily
- Pediatric Hypertension: 1 mg/kg once daily (up to 40 mg total)
- Heart Failure: 40 mg twice daily
- Post-Myocardial Infarction: 20 mg twice daily 2
From the Research
Valsartan Dosing
- The recommended starting dose of valsartan is 80 mg once daily, which can be increased to 160 mg once daily if required 3.
- In patients with hepatic dysfunction, the dose of valsartan should not exceed 80 mg once daily 3.
- For patients with heart failure, valsartan has been investigated at dosages ranging from 40 to 160 mg twice daily, with 160 mg being the optimal dose for initial therapy 4.
- The antihypertensive effect of valsartan increases in a predictable fashion over a wide dose range (20-320 mg), with the 80-mg dose being enhanced by doubling it to 160 mg 4.
Dose Titration
- The median time to achieve blood-pressure goal with valsartan monotherapy is 8.1 weeks with 160 mg and 6.1 weeks with 320 mg 5.
- The addition of hydrochlorothiazide (HCTZ) to valsartan reduces the median time to achieve blood-pressure goal to 2.6 weeks with valsartan 160 mg/HCTZ and 2.1 weeks with valsartan 320 mg/HCTZ 5.
- In patients with stage 2 hypertension, the median time to achieve blood-pressure goal is 4.3 weeks with valsartan 160 mg/HCTZ and 2.4 weeks with valsartan 320 mg/HCTZ 5.
Special Populations
- No dose adjustment is required for patients with a creatinine clearance > 10 ml/min 3.
- Valsartan is not recommended for patients with severe hepatic dysfunction and/or biliary cirrhosis 3.
- In patients with heart failure, valsartan has been shown to reduce the risk of mortality and morbidity when used in combination with conventional therapy 6.