What is the appropriate dosing for Valsartan (Diovan)?

From the Guidelines

Valsartan (Diovan) should be dosed at 20-40 mg once daily, with a target dose of 160 mg twice daily, as tolerated, for the management of heart failure, based on the most recent and highest quality evidence from the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1. The dosing of Valsartan can be adjusted based on individual patient response and tolerance, with careful monitoring of blood pressure, renal function, and serum potassium levels. Some key points to consider when dosing Valsartan include:

• Starting dose: 20-40 mg once daily
• Target dose: 160 mg twice daily
• Titration: The dose can be titrated up to the target dose as tolerated by the patient
• Monitoring: Regular monitoring of blood pressure, renal function, and serum potassium levels is essential to ensure safe and effective use of Valsartan
• Contraindications: Valsartan is contraindicated in patients with hypersensitivity to the medication, and caution should be exercised in patients with renal impairment, hyperkalemia, or hypotension. It's also important to note that Valsartan can be used in combination with other medications, such as beta blockers, ACE inhibitors, and diuretics, to achieve optimal blood pressure control and reduce the risk of cardiovascular events. In terms of administration, Valsartan can be taken orally, with or without food, and should be swallowed whole with a glass of water. Overall, the dosing of Valsartan should be individualized based on patient-specific factors, and careful monitoring and adjustment of the dose as needed to ensure optimal therapeutic outcomes and minimize adverse effects, as recommended by the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1.

From the FDA Drug Label

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. Valsartan tablets may be used over a dose range of 80 mg to 320 mg daily, administered once a day The usual recommended starting dose is 1 mg/kg once daily (up to 40 mg total) for pediatric patients. The recommended starting dose of valsartan tablet is 40 mg twice daily for heart failure, and 20 mg twice daily for post-myocardial infarction.

The appropriate dosing for Valsartan (Diovan) is:

• Adult Hypertension: 80 mg to 320 mg daily, administered once a day
• Pediatric Hypertension: 1 mg/kg once daily (up to 40 mg total), adjusted according to blood pressure response and tolerability, up to a maximum dose of 4 mg/kg once daily (maximum daily dose 160 mg)
• Heart Failure: 40 mg twice daily, uptitrated to 80 mg and 160 mg twice daily or to the highest dose tolerated by the patient
• Post-Myocardial Infarction: 20 mg twice daily, uptitrated to 40 mg twice daily, with subsequent titrations to a target maintenance dose of 160 mg twice daily, as tolerated by the patient 2

From the Research

Dosing for Valsartan (Diovan)

• The recommended starting dose for valsartan is 80 mg once daily, which can be increased to 160 mg once daily if required 3, 4.
• For patients with hepatic dysfunction, the dose should not exceed 80 mg once daily 3.
• In patients with hypertension, heart failure, or both, a daily dose of 160 mg may be the optimal dose for initial therapy 4.
• For children aged 6 years and older, the starting dose is 1.3 mg/kg once daily (maximum 40 mg), which can be adjusted according to blood pressure response (dose range 1.3-2.7 mg/kg daily; up to 160 mg) 5.
• Studies have shown that higher doses of valsartan, up to 320 mg, can provide greater blood pressure reductions and a higher proportion of patients reaching blood pressure goal 6, 7.
• Combination therapy with valsartan and hydrochlorothiazide has been shown to be more effective than monotherapy, with higher doses providing greater blood pressure reductions and a higher proportion of patients reaching blood pressure goal 6, 7.

Special Considerations

• 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.
• The dose of valsartan should be individualized in patients with heart failure, as rigid dose standardization may not be appropriate 4.