Valsartan Dosing for Hypertension and Heart Failure
For patients with hypertension, valsartan should be started at 80-160 mg once daily and titrated to a maximum of 320 mg once daily, while patients with heart failure should start at 40 mg twice daily and titrate to 160 mg twice daily. 1
Dosing for Hypertension
Initial Dosing
- Starting dose: 80 mg or 160 mg once daily for patients who are not volume-depleted 1
- The antihypertensive effect is substantially present within 2 weeks, with maximal reduction generally attained after 4 weeks 1
Dose Titration
- Dose range: 80 mg to 320 mg daily, administered once daily 1
- If additional antihypertensive effect is required over the starting dose range, the dose may be increased to a maximum of 320 mg or a diuretic may be added 1
- The 160 mg dose appears to be the optimal dose for initial therapy in most patients with essential hypertension based on efficacy/tolerability profile 2
Special Populations
- African-American patients may require higher doses (up to 640 mg in some studies) or combination therapy for optimal blood pressure control 3
- For pediatric patients (1-16 years), the recommended starting dose is 1 mg/kg once daily (up to 40 mg total) with a maximum dose of 4 mg/kg once daily (maximum 160 mg) 1
Dosing for Heart Failure
Initial Dosing
- Starting dose: 40 mg twice daily 1
- This lower starting dose is important to minimize the risk of hypotension in these potentially volume-depleted patients
Dose Titration
- Uptitrate to 80 mg and 160 mg twice daily or to the highest dose tolerated by the patient 1
- Consider reducing the dose of concomitant diuretics during uptitration 1
- The maximum daily dose administered in clinical trials is 320 mg in divided doses 1
- The Val-HeFT trial demonstrated efficacy using valsartan 160 mg twice daily in patients with chronic heart failure 4
Post-Myocardial Infarction
- May be initiated as early as 12 hours after a myocardial infarction 1
- Starting dose: 20 mg twice daily 1
- Uptitrate within 7 days to 40 mg twice daily, with subsequent titrations to a target maintenance dose of 160 mg twice daily, as tolerated 1
Monitoring and Adjustments
- Monitor blood pressure response and tolerability during dose adjustments
- If symptomatic hypotension or renal dysfunction occurs, consider dosage reduction 1
- For patients with heart failure, the European Society of Cardiology guidelines recommend checking serum potassium and creatinine after dose increases 5
Important Considerations
- Valsartan tablets and oral suspension are not substitutable on a milligram-per-milligram basis 1
- If a dose is missed, it should be administered as soon as possible, unless it is almost time for the next dose 1
- The dose should not be doubled to make up for a missed dose 1
Precautions and Contraindications
- Use with caution in patients with renal dysfunction or hypotension
- Monitor for hypotension, renal failure, and hyperkalemia 5
- Avoid in pregnancy due to risk of fetal harm
Valsartan's efficacy in heart failure has been demonstrated in large clinical trials, showing significant reductions in cardiovascular morbidity compared to placebo when added to standard therapy 4. The sustained AT₁-receptor blockade over 24 hours is better achieved with the 160 mg dose compared to 80 mg 6, which supports the higher dosing recommendations for heart failure patients.