Maximum Dose of Valsartan/HCTZ
The maximum recommended dose of valsartan/hydrochlorothiazide is 320 mg valsartan combined with 25 mg hydrochlorothiazide, administered once daily. 1, 2
Dosing Framework
Standard Maximum Dosing
- Valsartan component: Maximum 320 mg daily 3, 1
- HCTZ component: Maximum 25 mg daily when combined with valsartan 1, 2
- Administration: Once daily dosing is standard for hypertension 3
Available Combination Strengths
The evidence supports the following valsartan/HCTZ combinations, with the highest being the maximum dose 1:
- 80/12.5 mg
- 160/12.5 mg
- 160/25 mg
- 320/12.5 mg
- 320/25 mg (maximum dose)
Clinical Context for Maximum Dosing
Efficacy at Maximum Dose
- The 320/25 mg combination achieves blood pressure control in 84.8% of patients by week 8, compared to 54.2% with valsartan 320 mg alone 1
- In stage 2 hypertension specifically, 75.8% of patients reach BP goal <140/90 mmHg by week 8 with the maximum dose 1
- Median time to blood pressure goal is 2.1 weeks with valsartan 320 mg/HCTZ compared to 6.1 weeks with valsartan 320 mg monotherapy 1
Tolerability Profile
- Discontinuation rates due to adverse events remain low even at maximum doses 1
- The combination is generally as well-tolerated as placebo across the dose range 4
- HCTZ-induced hypokalemia is actually less common during combination therapy than with HCTZ alone 4
Important Caveats
Heart Failure Dosing Differs
- For heart failure with reduced ejection fraction, valsartan is dosed 160 mg twice daily (total 320 mg/day) without HCTZ 5
- The twice-daily regimen for heart failure is distinct from once-daily hypertension dosing 3
- HCTZ is not part of guideline-directed medical therapy for heart failure 5
Titration Approach
- Start with lower combination doses (e.g., 160/12.5 mg) and titrate upward every 2-4 weeks based on blood pressure response 1, 2
- Initial combination therapy achieves faster blood pressure control than starting with monotherapy and adding the second agent later 2