What is the recommended dosage range for Valsartan (Angiotensin II receptor antagonist) in adults with hypertension or heart failure?

Valsartan Dosage Recommendations for Hypertension and Heart Failure

For adults with hypertension, the recommended dosage range for valsartan is 80-320 mg once daily, while for heart failure patients, the target dose is 160 mg twice daily (320 mg total daily dose). 1, 2

Dosage for Hypertension

• The recommended starting dose for hypertension is 80 mg or 160 mg once daily in patients who are not volume-depleted 1
• Dosage may be increased to a maximum of 320 mg daily, administered once a day 1
• The antihypertensive effect is substantially present within 2 weeks, with maximal reduction generally attained after 4 weeks 1
• If additional blood pressure reduction is required, the dose may be increased or a diuretic may be added 1
• Higher doses provide greater benefits, with the 160 mg dose achieving sustained AT1-receptor blockade over 24 hours 3

Dosage for Heart Failure

• The recommended starting dose for heart failure is 40 mg twice daily 1
• Uptitrate to 80 mg and then 160 mg twice daily, or to the highest dose tolerated by the patient 1, 2
• The target dose is 160 mg twice daily (320 mg total daily dose), with at least 50% of target dose (160 mg daily) recommended as the minimum effective dose 2
• Consider reducing the dose of concomitant diuretics 1
• The maximum daily dose administered in clinical trials is 320 mg in divided doses 1
• Therapies should be adjusted no more frequently than every 2 weeks to target doses or maximally tolerated doses 2

Post-Myocardial Infarction Dosing

• May be initiated as early as 12 hours after a myocardial infarction 1
• Starting dose is 20 mg twice daily 1
• Patients may be uptitrated within 7 days to 40 mg twice daily, with subsequent titrations to a target maintenance dose of 160 mg twice daily, as tolerated 1
• Consider dosage reduction if symptomatic hypotension or renal dysfunction occurs 1

Special Considerations

• Monitor for hypotension, renal impairment, and hyperkalemia, especially when initiating therapy or increasing doses 2
• Many physicians use doses of valsartan for heart failure that are too low, which may not provide optimal benefits 2
• To achieve maximal benefits in heart failure with reduced ejection fraction (HFrEF), valsartan must be titrated to maximally tolerated doses 2
• Temporary dose reductions may be necessary for some patients, but efforts should be made to return to target doses when possible 2
• Once-daily dosing has been shown to have a similar safety and tolerability profile as twice-daily dosing in heart failure patients 4

Pediatric Dosing (1-16 Years of Age)

• The usual recommended starting dose is 1 mg/kg once daily (up to 40 mg total) 1
• A higher starting dose of 2 mg/kg may be considered when greater blood pressure reduction is needed 1
• Dosage should be adjusted according to blood pressure response and tolerability, up to a maximum of 4 mg/kg once daily (maximum daily dose 160 mg) 1
• Not recommended in children less than 1 year of age 1

Important Administration Notes

• 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
• Valsartan tablets and oral suspension are not substitutable on a milligram-per-milligram basis 1