From the Guidelines
To switch from lisinopril 20mg daily to valsartan, I recommend starting valsartan at 160mg twice daily, as this is the target dose according to the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure 1. The day after taking the last dose of lisinopril, begin the valsartan. No overlap period is needed as both medications work on the renin-angiotensin system. Some key points to consider when switching from an ACE inhibitor like lisinopril to an ARB like valsartan include:
- Monitoring blood pressure for 2-4 weeks after switching to ensure adequate control
- The typical maintenance dose range for valsartan is 80-320mg daily, so the doctor may adjust the dose based on the blood pressure response
- Both medications treat similar conditions (hypertension, heart failure, diabetic kidney disease), but valsartan may cause less cough than lisinopril
- Valsartan may be uptitrated in four steps, as seen in the VALIANT study 1
- Continue taking the medication at the same time each day, and report any side effects like dizziness, elevated potassium levels, or significant blood pressure changes to the healthcare provider. It's also worth noting that the 2020 ACC/AHA guidelines provide target doses for various ACE inhibitors and ARBs, including lisinopril and valsartan, which can guide the switching process 1.
From the FDA Drug Label
In controlled trials, the antihypertensive effect of once-daily valsartan 80 mg was similar to that of once-daily enalapril 20 mg or once-daily lisinopril 10 mg.
The equivalent dose of valsartan to lisinopril 20mg daily is not directly stated in the label, but based on the information provided, lisinopril 10mg is comparable to valsartan 80mg. Therefore, lisinopril 20mg would be approximately equivalent to valsartan 160mg. However, this is an extrapolation and not a direct conversion, so it should be used with caution. 2
From the Research
Switching from Lisinopril to Valsartan
- The decision to switch from lisinopril 20mg daily to valsartan depends on various factors, including the patient's medical condition, response to treatment, and potential side effects 3.
- Valsartan has been shown to be as effective as lisinopril in reducing blood pressure and slowing the progression of chronic heart failure (CHF) 4, 3.
- A study comparing valsartan 160mg with lisinopril 20mg found that both treatments were similarly effective in reducing sitting blood pressure, with mean systolic/diastolic blood pressure reductions of 31.2/15.9 mmHg and 31.4/15.9 mmHg, respectively 3.
- However, valsartan was associated with a significantly reduced risk of adverse events, especially cough, compared to lisinopril 3.
Considerations for Switching
- When switching from lisinopril to valsartan, it is essential to monitor the patient's blood pressure and adjust the dosage as needed 3.
- The combination of valsartan and captopril has been shown to increase the rate of adverse events without improving survival, so it is crucial to carefully consider the potential benefits and risks of combination therapy 5.
- Valsartan has been found to be as effective as captopril in patients with heart failure or left ventricular dysfunction after myocardial infarction, and it may be a suitable alternative for patients who cannot tolerate ACE inhibitors 4, 5.
Potential Benefits and Risks
- The potential benefits of switching from lisinopril to valsartan include improved tolerability and reduced risk of adverse events, such as cough 3.
- However, it is essential to carefully consider the potential risks and benefits of switching therapies, particularly in patients with complex medical conditions or those taking multiple medications 6, 5.
- The VALIANT trial demonstrated that valsartan is as effective as captopril in reducing mortality and cardiovascular morbidity in patients with heart failure or left ventricular dysfunction after myocardial infarction 4, 5.