What is the typical dosing for Valsartan (Angiotensin II receptor antagonist) in patients with hypertension or heart failure?

Valsartan Dosing for Hypertension and Heart Failure

For hypertension, valsartan should be started at 80-160 mg once daily and titrated up to 320 mg daily as needed; for heart failure, initiate at 40 mg twice daily and uptitrate to the target dose of 160 mg twice daily. 1, 2

Dosing for Hypertension

• The recommended starting dose for hypertension is 80 mg or 160 mg once daily in patients who are not volume-depleted 2
• The dose may be increased to a maximum of 320 mg daily, administered once daily 2
• The antihypertensive effect is substantially present within 2 weeks, with maximal reduction generally attained after 4 weeks 2
• If additional antihypertensive effect is required beyond the starting dose, the dose may be increased up to 320 mg or a diuretic may be added 2

Dosing for Heart Failure

• The recommended starting dose for heart failure is 40 mg twice daily 2
• Uptitrate to 80 mg twice daily and then to 160 mg twice daily (target dose) or to the highest dose tolerated by the patient 2, 1
• Dosing adjustments should be made no more frequently than every 2 weeks to allow for clinical stabilization 1
• Consider reducing the dose of concomitant diuretics when initiating valsartan therapy 2
• The maximum daily dose administered in clinical trials was 320 mg in divided doses 2

Dosing for Post-Myocardial Infarction

• Valsartan may be initiated as early as 12 hours after a myocardial infarction 2
• Start with 20 mg twice daily 2
• Uptitrate within 7 days to 40 mg twice daily, with subsequent titrations to a target maintenance dose of 160 mg twice daily as tolerated 2
• Consider dosage reduction if symptomatic hypotension or renal dysfunction occurs 2

Importance of Target Dose Achievement

• Higher doses of valsartan provide greater benefits than lower doses in clinical trials 3, 4
• At least 50% of the target dose is recommended as the minimum effective dose for adequate treatment effect 1, 3
• The 160 mg dose provides sustained AT1-receptor blockade over 24 hours, while lower doses may not maintain effectiveness throughout the dosing interval 5
• Many physicians use doses of valsartan for heart failure that are too low, which may not provide optimal benefits for mortality and morbidity reduction 3

Monitoring and Dose Adjustments

• Monitor blood pressure, renal function, and electrolytes during dose titration 1
• If symptomatic hypotension or renal dysfunction occurs, consider temporary dose reduction 1, 2
• Temporary dose reductions may be necessary for some patients, but efforts should be made to return to target doses when possible to ensure optimal outcomes 1, 3
• No dose adjustment is required for patients with creatinine clearance >10 mL/min 2
• For patients with hepatic dysfunction, the dose should not exceed 80 mg once daily 2

Special Considerations

• Valsartan tablets and oral suspension are not substitutable on a milligram-per-milligram basis (systemic exposure is 60% higher with suspension) 2
• For patients intolerant of ACE inhibitors, valsartan is a recommended alternative 1
• The VALIANT trial found valsartan to be noninferior to captopril in post-MI patients 6
• In the Val-HeFT trial, valsartan 160 mg twice daily reduced the combined endpoint of mortality and morbidity by 13.2% compared with placebo in patients with chronic heart failure 7

Valsartan's efficacy in both hypertension and heart failure has been well-established, with the optimal dose being 160 mg once daily for hypertension and 160 mg twice daily for heart failure to achieve maximal clinical benefits while maintaining an excellent safety profile 4, 8.