Dosing Schedule for Valsartan and Amlodipine
Valsartan should be initiated at 20-40 mg once daily and titrated to a target dose of 160 mg twice daily, while amlodipine should be started at 2.5-5 mg once daily with titration to 10 mg once daily for optimal blood pressure control and cardiovascular outcomes. 1, 2
Valsartan Dosing
Initial Dosing
- Start with 20-40 mg once daily for hypertension in patients who are not volume-depleted 1, 2
- For heart failure patients, start with 40 mg twice daily 2
- For post-myocardial infarction patients, start with 20 mg twice daily as early as 12 hours after MI 2
Titration Schedule
- Uptitrate valsartan every 1-2 weeks based on blood pressure response, symptoms, and laboratory findings 1
- For hypertension: Increase to 80 mg, then 160 mg, and finally 320 mg once daily if needed 2
- For heart failure: Uptitrate to 80 mg twice daily, then 160 mg twice daily 2
- For post-MI: Uptitrate to 40 mg twice daily within 7 days, then to target dose of 160 mg twice daily 2
Amlodipine Dosing
Initial Dosing
- Start with 2.5-5 mg once daily 1, 3
- Lower starting dose (2.5 mg) recommended for elderly patients or those with hepatic impairment
Titration Schedule
- Titrate to 5 mg, then 10 mg once daily based on blood pressure response 3, 4
- Maximum dose: 10 mg once daily 4
- Allow 7-14 days between dose adjustments to assess full effect
Combination Therapy Considerations
When to Use Combination Therapy
- When monotherapy with either agent fails to achieve target blood pressure 5, 6
- For patients with stage 2 hypertension who need >20/10 mmHg reduction in BP 3
- For elderly and Black patients who often require multiple agents for adequate control 3
Dosing of Combination
- Fixed-dose combinations are available and improve adherence 5
- Combination of amlodipine 5 mg/valsartan 160 mg provides significantly better blood pressure control than valsartan 160 mg alone (61.3% vs 39.3% achieving target BP) 6
Administration Timing
- Bedtime administration of both medications together provides the greatest BP reduction (24.7/13.5 mmHg) compared to morning dosing (17.4/13.4 mmHg) 7
- Bedtime dosing also results in better control of morning BP surge and improved dipper pattern 7
Special Considerations
Drug Interactions
- No significant interaction between amlodipine and valsartan that would require dose adjustment 1
- When combining with statins, be aware that amlodipine has minimal effect on statin metabolism 1
- Avoid doses of lovastatin or simvastatin >20 mg daily when coadministered with amlodipine 1
Monitoring
- Check blood pressure and renal function within 1-2 weeks after initiating or changing doses 8
- Monitor for peripheral edema, which is less common with combination therapy than with amlodipine alone 5
- For heart failure patients, consider reducing the dose of concomitant diuretics when initiating valsartan 2
Missed Doses
- If a dose is missed, take it as soon as possible, unless it's almost time for the next dose 2
- Do not double the dose to make up for a missed dose 2
By following this dosing schedule and monitoring approach, you can optimize the effectiveness of valsartan and amlodipine therapy while minimizing potential adverse effects.