From the Guidelines
The starting dose of valsartan is 20-40 mg once daily. This dose is recommended for adults with heart failure, as stated in the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1. Valsartan works by blocking angiotensin II receptors, causing blood vessels to relax and widen, which improves heart function and reduces symptoms.
- The target dose of valsartan is 160 mg twice daily, as indicated in the guideline 1.
- Dose adjustments can be made based on patient response and tolerance, with a maximum daily dose of 320 mg.
- Patients should be advised to take valsartan consistently at the same time each day and to continue the medication even if feeling well, as heart failure is typically a chronic condition.
- Regular monitoring of blood pressure, kidney function, and electrolyte levels is important during treatment with valsartan, as stated in the guideline 1.
- The 2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment also recommends a starting dose of 40 mg twice daily for valsartan 1.
- It is essential to note that the dose of valsartan may need to be adjusted in patients with renal impairment or other comorbidities, as stated in the guideline 1.
From the FDA Drug Label
The recommended starting dose of valsartan tablet is 80 mg or 160 mg once daily when used as monotherapy in patients who are not volume-depleted. The usual recommended starting dose is 1 mg/kg once daily (up to 40 mg total). The recommended starting dose of valsartan tablet is 40 mg twice daily. The recommended starting dose of valsartan tablet is 20 mg twice daily.
The starting dose of valsartan is:
- 80 mg or 160 mg once daily for adult hypertension
- 1 mg/kg once daily (up to 40 mg total) for pediatric hypertension (1 to 16 years of age)
- 40 mg twice daily for heart failure
- 20 mg twice daily for post-myocardial infarction 2
From the Research
Starting Dose of Valsartan
- The starting dose of valsartan can vary depending on the patient's condition and the specific treatment goals 3, 4, 5, 6, 7.
- For patients with essential hypertension, a starting dose of 80 mg once daily is commonly used, with the option to titrate up to 160 mg or 320 mg as needed 3, 5, 7.
- In patients with heart failure, the starting dose may be 40 mg twice daily, with the option to titrate up to 160 mg twice daily 3, 4.
- For patients with uncomplicated hypertension, a starting dose of 80 mg or 160 mg once daily may be used, with the option to add hydrochlorothiazide (HCTZ) 12.5 mg or 25 mg if needed 6.
- The dose-response efficacy of valsartan has been studied, and the results show that the reduction in blood pressure increases with increasing dose levels, up to 160 mg once daily 7.
Dose Titration
- Dose titration may be necessary to achieve optimal blood pressure control, and the dose can be increased gradually as needed and tolerated 3, 5, 6, 7.
- The median time to achieve blood pressure goal has been shown to be shorter with higher doses of valsartan, and with the addition of HCTZ 6.
Safety and Tolerability
- Valsartan has been shown to be well tolerated, with a low incidence of adverse events, including cough and orthostatic hypotension 4, 5, 7.
- The safety and tolerability of valsartan have been evaluated in several studies, and the results show that it is generally well tolerated, with a favorable benefit-risk profile 4, 6.