What is the typical dosage and usage of Diovan (valsartan) for treating high blood pressure or heart failure?

Dosage and Usage of Diovan (Valsartan) for Hypertension and Heart Failure

For hypertension, Diovan (valsartan) should be started at 80-160 mg once daily and can be titrated up to 320 mg daily; for heart failure, start with 40 mg twice daily and uptitrate to 160 mg twice daily as tolerated. 1

Dosing for Hypertension

Adult Hypertension

• Starting dose: 80 mg or 160 mg once daily for patients who are not volume-depleted 1
• Dose range: 80 mg to 320 mg daily, administered once a day 1
• Antihypertensive effect is substantially present within 2 weeks, with maximal reduction generally attained after 4 weeks 1
• If additional blood pressure reduction is needed, the dose may be increased to a maximum of 320 mg or a diuretic may be added 1
• The combination of valsartan with hydrochlorothiazide (Diovan/HCT) is even more effective, controlling blood pressure in approximately 70% of cases 2

Pediatric Hypertension (1-16 years)

• Starting dose: 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
• Maximum dose: 4 mg/kg once daily (not to exceed 160 mg daily) 1
• Not recommended for children less than 1 year of age 1

Dosing for Heart Failure

• Starting dose: 40 mg twice daily 1
• Uptitration: Increase to 80 mg and 160 mg twice daily, or to the highest dose tolerated by the patient 1
• Maximum daily dose used in clinical trials: 320 mg in divided doses 1
• Consider reducing the dose of concomitant diuretics when initiating valsartan 1
• Target dose: 160 mg twice daily (total daily dose of 254 mg has been shown effective in clinical trials) 3

Dosing for Post-Myocardial Infarction

• Initiation: May begin as early as 12 hours after a myocardial infarction 1
• Starting dose: 20 mg twice daily 1
• Uptitration: 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
• May be given with other standard post-myocardial infarction treatments (thrombolytics, aspirin, beta-blockers, and statins) 1

Important Administration Considerations

• Valsartan can be administered with other antihypertensive agents 1
• If a dose is missed, it should be taken as soon as possible, unless it's almost time for the next dose (do not double the dose) 1
• For patients who cannot swallow tablets, an oral suspension can be prepared (4 mg/mL) 1
• The oral suspension is not substitutable on a milligram-per-milligram basis with tablets (60% higher systemic exposure) 1

Monitoring and Dose Adjustments

• Monitor for symptomatic hypotension or renal dysfunction, especially in post-MI patients 1
• For heart failure patients, careful individualization of therapy is necessary 4
• If symptomatic hypotension occurs, consider reducing the dose of concomitant diuretics or temporarily lowering the valsartan dose 1

Special Considerations

• When used as an alternative to ACE inhibitors in heart failure patients, valsartan has fewer side effects such as cough 3
• For patients with heart failure who are intolerant of ACE inhibitors, valsartan is a recommended alternative 3
• In ST-elevation myocardial infarction patients, valsartan is listed as an appropriate angiotensin receptor blocker option 3

Common Pitfalls and Caveats

• Avoid use in pregnancy (contraindicated) 5
• Use caution in patients with renal artery stenosis 5
• Do not combine tablet and suspension dosage forms to achieve the total dose 1
• When switching between suspension and tablets, the dose may need adjustment due to different bioavailability 1
• For optimal outcomes in hypertension, the 160 mg dose appears to provide the best efficacy/tolerability ratio 4