What is the dosing of Valsartan (Angiotensin II Receptor Antagonist)?

From the Guidelines

Valsartan should be initiated at a dose of 20-40 mg once daily and titrated to a target dose of 160 mg twice daily for patients with heart failure, as recommended by the most recent guidelines 1. The dosing of valsartan is crucial in managing heart failure, and the initial dose should be adjusted based on the patient's tolerance.

• The starting dose for heart failure is typically lower, at 20-40 mg once daily, and should be gradually increased to the target dose of 160 mg twice daily, as tolerated.
• For patients with hypertension, the starting dose can be 80-160 mg once daily, with a maximum dose of 320 mg daily.
• In post-myocardial infarction patients, the starting dose should be 20 mg twice daily, and increased to 160 mg twice daily if possible.
• Dosing should be adjusted for patients with hepatic or renal impairment, with lower starting doses recommended.
• Valsartan works by blocking angiotensin II receptors, preventing vasoconstriction and aldosterone secretion, thereby lowering blood pressure and reducing cardiac workload.
• Side effects may include dizziness, hypotension, hyperkalemia, and renal dysfunction, particularly when combined with other medications affecting the renin-angiotensin-aldosterone system. The most recent guidelines from the American College of Cardiology/American Heart Association 1 provide the recommended dosing for valsartan in patients with heart failure.
• The guidelines recommend a target dose of 160 mg twice daily for valsartan, which is consistent with the dosing recommended in other studies 1.
• However, the most recent guidelines 1 should be prioritized when determining the dosing of valsartan, as they provide the most up-to-date recommendations based on the latest evidence.

From the FDA Drug Label

2.2 Adult Hypertension 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. 2.3 Pediatric Hypertension 1 to 16 Years of Age The usual recommended starting dose is 1 mg/kg once daily (up to 40 mg total). 2.4 Heart Failure The recommended starting dose of valsartan tablet is 40 mg twice daily. 2.5 Post-Myocardial Infarction Valsartan tablets may be initiated as early as 12 hours after a myocardial infarction. The recommended starting dose of valsartan tablet is 20 mg twice daily.

The dosing of Valsartan varies based on the condition being treated.

• Adult Hypertension: The recommended starting dose is 80 mg or 160 mg once daily.
• Pediatric Hypertension: The usual recommended starting dose is 1 mg/kg once daily (up to 40 mg total).
• Heart Failure: The recommended starting dose is 40 mg twice daily.
• Post-Myocardial Infarction: The recommended starting dose is 20 mg twice daily 2.

From the Research

Dosing of Valsartan

• The optimal daily dose of valsartan in patients with hypertension, heart failure, or both is 160 mg, as it provides the best ratio between efficacy and tolerability 3.
• Valsartan has been investigated in patients with heart failure at dosages ranging from 40 to 160 mg BID, and rigid dose standardization may not be appropriate due to the need for careful individualization of therapy 3.
• In patients with chronic heart failure, valsartan 160 mg twice daily reduced the risk of the combined endpoint of mortality and morbidity by 13.2% compared with placebo 4.
• The most common adverse events in the valsartan group that led to discontinuation of treatment were dizziness, renal impairment, and hypotension 4.
• Valsartan is generally well tolerated, with renal impairment, elevated serum creatinine and potassium levels, and dizziness being the most common adverse effects 5.
• The efficacy and duration of action of valsartan in patients with essential hypertension have been compared with other angiotensin II receptor blockers, and valsartan has been shown to have a long-acting property, persisting over 24 hours when administered once daily in the morning 6.
• The antihypertensive effects of valsartan on home systolic BP and home diastolic BP have been shown to be significant, with a morning effect versus evening effect ratio (M/E ratio) of 0.82/0.88 6.