What is the recommended dosage and usage of Valsartan (Angiotensin II receptor antagonist) for treating high blood pressure and heart failure?

Valsartan Dosage and Usage for Hypertension and Heart Failure

For hypertension, valsartan should be started at 80-160 mg once daily and titrated up to 320 mg once daily as needed, while for heart failure, the recommended starting dose is 40 mg twice daily with uptitration 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
• Valsartan may be used over a dose range of 80-320 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 to a maximum of 320 mg or a diuretic may be added 2
• Higher doses of valsartan provide greater benefits with sustained AT1-receptor blockade over 24 hours achieved with the 160 mg dose 3

Dosing for Heart Failure

• For heart failure, the recommended starting dose is 40 mg twice daily 1, 2
• Uptitrate to 80 mg and then to 160 mg twice daily, or to the highest dose tolerated by the patient 1, 2
• The target dose for heart failure 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 3, 1
• The maximum daily dose administered in clinical trials is 320 mg in divided doses 2
• Dose adjustments should be made no more frequently than every 2 weeks to allow for proper assessment of patient response 3, 1

Special Considerations and Monitoring

• Consider reducing the dose of concomitant diuretics when initiating valsartan for heart failure 2
• Monitor blood pressure, renal function, and electrolytes during dose titration, particularly when initiating therapy or increasing doses 3, 1
• If symptomatic hypotension or renal dysfunction occurs, consider dosage reduction 2
• Temporary dose reductions may be necessary for some patients, but efforts should be made to return to target doses when possible for optimal benefits 3
• For post-myocardial infarction patients, valsartan may be initiated as early as 12 hours after MI, starting at 20 mg twice daily and titrating to a target maintenance dose of 160 mg twice daily 2

Formulation Considerations

• 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
• Oral suspension is recommended for pediatric patients aged 1 to 5 years, patients >5 years who cannot swallow tablets, and when the calculated dose does not correspond to available tablet strengths 2

Clinical Efficacy

• In heart failure patients, valsartan at the target dose of 160 mg twice daily reduced the combined endpoint of mortality and morbidity by 13.2% compared with placebo in the Val-HeFT trial 4
• Studies have shown that higher doses of valsartan have provided greater benefits than lower doses, with little evidence that subtarget doses yield comparable survival benefits 1, 5
• Many physicians use doses of valsartan for heart failure that are too low, which may not provide optimal benefits 3

Safety Profile

• Valsartan is generally well-tolerated with a safety profile comparable to placebo across the recommended dose range 6, 7
• The most common adverse events that may lead to discontinuation include dizziness, renal impairment, and hypotension 4
• Once-daily dosing for hypertension and twice-daily dosing for heart failure have similar safety and efficacy profiles 8

Remember that to achieve maximal benefits in heart failure with reduced ejection fraction, valsartan must be titrated to maximally tolerated doses, with a clear target of 160 mg twice daily 3, 1.