What is the starting dose of Diovan (valsartan) for adults with hypertension?

Starting Dose of Valsartan (Diovan) for Adult Hypertension

The recommended starting dose of valsartan for adults with hypertension is 80 mg or 160 mg once daily when used as monotherapy in patients who are not volume-depleted. 1

Dosing Guidelines

The FDA-approved valsartan dosing recommendations for adult hypertension include:

• Initial dose: 80 mg or 160 mg once daily
• Dose range: 80 mg to 320 mg daily, administered once daily
• Timing of effect: Substantial antihypertensive effect is present within 2 weeks, with maximal reduction generally attained after 4 weeks

Dose Titration

• If additional blood pressure reduction is required beyond the starting dose, the dose may be increased up to a maximum of 320 mg daily
• Alternatively, a diuretic may be added (which often provides greater effect than dose increases beyond 80 mg)

Special Populations and Considerations

Heart Failure Patients

• Different dosing applies for heart failure: starting dose of 40 mg twice daily, with uptitration to 80 mg and 160 mg twice daily 1
• Target dose in heart failure is 160 mg twice daily (320 mg total daily) 2

Post-Myocardial Infarction

• Starting dose: 20 mg twice daily
• Uptitration to target maintenance dose of 160 mg twice daily as tolerated 1

Combination Therapy

• Valsartan may be administered with other antihypertensive agents
• Fixed-dose combinations with hydrochlorothiazide (such as 80/12.5 mg or 160/12.5 mg) are commonly used and can control blood pressure in approximately 70% of cases 3

Clinical Efficacy Considerations

• The antihypertensive effect of valsartan increases in a predictable fashion over the dose range of 20-320 mg 4
• The 160 mg dose appears to be the optimal dose for initial therapy in patients with essential hypertension based on efficacy/tolerability profile 4
• While 80 mg daily is effective, doubling to 160 mg enhances the antihypertensive efficacy while maintaining a tolerability profile comparable to placebo 4
• A 160 mg dose provides more sustained angiotensin II type 1 receptor blockade over 24 hours compared to 80 mg 5

Monitoring Recommendations

• Follow-up evaluation of adherence and response to treatment should occur at monthly intervals until blood pressure control is achieved 6
• Monitor blood pressure, renal function, and electrolytes 1-2 weeks after starting treatment and after each dose increase 2

Common Pitfalls to Avoid

1. Starting with too low a dose (40 mg) may result in inconsistent antihypertensive effect 7
2. Failing to recognize that valsartan tablets and oral suspension are not substitutable on a milligram-per-milligram basis 1
3. Not considering combination therapy when monotherapy is insufficient to reach blood pressure goals
4. Overlooking contraindications such as pregnancy or severe bilateral renal artery stenosis

Remember that valsartan, like other ARBs, is generally well-tolerated with fewer side effects like cough compared to ACE inhibitors, making it a good option for patients who cannot tolerate ACE inhibitors.