From the Guidelines
Exforge dosing should start at 5/160 mg once daily, with a maximum recommended dose of 10/320 mg once daily, as per the guidelines outlined in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
Key Considerations for Exforge Dosing
- The medication combines amlodipine, a calcium channel blocker, and valsartan, an angiotensin II receptor blocker, to treat hypertension.
- The standard starting dose can be adjusted based on blood pressure response.
- Patients already taking either component separately can initiate the equivalent combined dose.
- Elderly patients, those with hepatic impairment, and those with severe renal impairment should start at lower doses.
Mechanism of Action and Administration
- Exforge works by combining two mechanisms: amlodipine relaxes blood vessels, while valsartan blocks the action of angiotensin II, a hormone that narrows blood vessels.
- The medication should be taken consistently with respect to meals, and patients should maintain regular dosing times to ensure stable blood pressure control.
Important Guidelines and Recommendations
- According to the guidelines, Exforge is a suitable option for patients with hypertension, but dosing should be individualized based on patient response and tolerability 1.
- It is essential to monitor patients for potential side effects, such as pedal edema, and adjust the dose accordingly.
- The guidelines also emphasize the importance of regular follow-up and monitoring to ensure optimal blood pressure control and minimize the risk of adverse effects.
From the Research
Exforge Doses
- The Exforge doses are available in single-pill combinations of amlodipine and valsartan, with dosages of 5/160 mg and 10/160 mg 2, 3, 4.
- These doses may be used in patients whose blood pressure is not adequately controlled on either component monotherapy, and as initial therapy in patients who are likely to need multiple drugs to achieve their blood pressure goals 2.
- The antihypertensive efficacy of combinations of once-daily oral amlodipine and valsartan has been demonstrated in several large, randomized, double-blind clinical trials of 8-16 weeks' duration 2, 4.
- Combination therapy with amlodipine and valsartan was generally well tolerated, with a lower incidence of peripheral edema compared to amlodipine monotherapy 2, 4.
Dosage Regimens
- Amlodipine/valsartan 5/160 mg or 10/160 mg were used after previous ineffective therapy was discontinued, with patients visiting their physician's office every 4 weeks 3.
- The majority of patients had grades 2 and 3 hypertension at baseline, but by the end of the program, 74% of patients had normal or high normal blood pressure, and grade 3 hypertension was preserved in only 0.2% of patients 3.
- Blood pressure goals were achieved in 79.5% of patients, with a marked antihypertensive effect in different subgroups of patients with previously uncontrolled hypertension 3.
Efficacy and Safety
- The combinations of amlodipine 5 to 10 mg + valsartan 160 mg and lisinopril 10 to 20 mg + hydrochlorothiazide 12.5 mg were well tolerated and efficacious, with both treatments associated with achievement of blood pressure goals in the majority of adult patients with stage 2 hypertension 5.
- Amlodipine/valsartan achieved significantly greater reductions in mean sitting diastolic and systolic blood pressure than amlodipine or valsartan monotherapy, or placebo in two randomized, double-blind, factorial trials in patients with mild to moderate hypertension 4.