Maximum Recommended Dose of Valsartan
The maximum recommended dose of valsartan is 320 mg daily for hypertension and 160 mg twice daily (320 mg total daily) for heart failure and post-myocardial infarction. 1, 2
Dosing by Indication
Hypertension
- Starting dose: 80 mg or 160 mg once daily in patients who are not volume-depleted 2
- Dose range: 80 mg to 320 mg daily, administered once daily 2
- Maximum dose: 320 mg daily 2, 3
- Antihypertensive effect is substantially present within 2 weeks with maximal reduction generally attained after 4 weeks 2
Heart Failure
- Starting dose: 40 mg twice daily 2
- Titration: Uptitrate to 80 mg and 160 mg twice daily or to the highest dose tolerated 2
- Maximum dose: 160 mg twice daily (320 mg total daily) 1, 2
- Mean dose achieved in clinical trials: 254 mg total daily 1
Post-Myocardial Infarction
- Starting dose: 20 mg twice daily (can be initiated as early as 12 hours after MI) 2
- Titration: Uptitrate within 7 days to 40 mg twice daily, with subsequent titrations to target maintenance dose 2
- Target maintenance dose: 160 mg twice daily (320 mg total daily) 2
Special Populations
Pediatric Patients
- For ages 1-16 years: Starting dose is 1 mg/kg once daily (up to 40 mg total) 2
- Maximum dose: 4 mg/kg once daily (maximum daily dose 160 mg) 2
- Not recommended for children less than 1 year of age 2
Hepatic Impairment
- For patients with hepatic dysfunction: Dose should not exceed 80 mg once daily 2, 4
- Not recommended for patients with severe hepatic dysfunction and/or biliary cirrhosis 4
Dosing Considerations
- When switching between ACE inhibitors and ARBs, start at a lower dose and titrate up 5
- For heart failure patients, achieving target doses is associated with improved outcomes 5
- Valsartan tablets and oral suspension are not substitutable on a milligram-per-milligram basis 2
- The systemic exposure to valsartan is 60% higher with the suspension compared to tablets 2
Dosing Equivalence
- Valsartan 160 mg twice daily (320 mg total) is equivalent to lisinopril 20-40 mg daily 5
- In heart failure treatment, valsartan can be administered as an alternative to ACE inhibitors in patients who are intolerant to ACE inhibitors 1
Monitoring During Dose Titration
- Monitor for hypotension, especially in patients who are volume-depleted 2
- Monitor renal function and serum potassium levels, particularly in heart failure patients 1
- Consider reducing the dose of concomitant diuretics when initiating valsartan for heart failure 2
Administration
- For hypertension: Once daily dosing 3
- For heart failure or post-MI: Twice daily dosing 3, 6
- If a dose is missed, it should be administered as soon as possible, unless it is almost time for the next dose 2
Valsartan has demonstrated excellent efficacy and tolerability across its dosing range, with a safety profile comparable to placebo even at maximum doses 3, 7.