Should Diovan (Valsartan) be started at 80 mg daily or less?

Starting Diovan (Valsartan) Dosage Recommendation

For most patients, Diovan (valsartan) should be initiated at 80 mg once daily when used as monotherapy for hypertension. 1

Dosing Rationale and Guidelines

The FDA-approved labeling for valsartan clearly states that the recommended starting dose is 80 mg or 160 mg once daily for adults with hypertension who are not volume-depleted 1. This is supported by multiple clinical practice guidelines:

• The 2018 ACC/AHA hypertension guideline lists valsartan's usual dose range as 80-320 mg daily 2
• The 2020 International Society of Hypertension guidelines recommend starting with a low dose ARB for non-black patients 2

Dose Titration

• Initial dose: 80 mg once daily
• The antihypertensive effect is substantially present within 2 weeks
• Maximum effect is generally attained after 4 weeks
• If additional blood pressure reduction is needed, the dose may be increased to a maximum of 320 mg daily or a diuretic may be added 1

Special Considerations

Heart Failure Patients

For patients with heart failure, a different dosing approach is needed:

• Starting dose: 40 mg twice daily
• Uptitrate to 80 mg and 160 mg twice daily as tolerated
• Target dose: 160 mg twice daily (320 mg total daily) 2, 1

Post-Myocardial Infarction

• Starting dose: 20 mg twice daily
• Uptitrate to target maintenance dose of 160 mg twice daily 1

Clinical Evidence

Clinical studies have demonstrated that:

• The antihypertensive efficacy of valsartan 80 mg can be enhanced by doubling it to 160 mg while maintaining a tolerability profile comparable to placebo 3
• In patients with mild to moderate hypertension, valsartan 80 mg/day produced significant reductions in both systolic and diastolic blood pressure within 2 weeks of treatment 4
• Hypotensive effect was satisfactory or good in 80% of patients at the 80 mg/day dose, with only 15% of patients requiring dose elevation to 160 mg/day 5

Common Pitfalls to Avoid

1. Starting with too low a dose: Some clinicians start with 40 mg, which has been shown to have inconsistent antihypertensive effects 6

2. Failure to monitor appropriately: Check blood pressure, renal function and electrolytes after initiation and during dose titration

3. Contraindications: Do not use in pregnancy, and use with caution in patients with severe bilateral renal artery stenosis

4. Drug interactions: Do not combine with ACE inhibitors or direct renin inhibitors due to increased risk of adverse effects 2

In conclusion, based on the FDA labeling and clinical guidelines, 80 mg daily is the appropriate starting dose for most patients with hypertension, with the option to increase to 160 mg if needed for better blood pressure control.