As an angiotensin II receptor antagonist, valsartan is widely used in the treatment of hypertension, heart failure, and post-myocardial infarction. Appropriate selection of dosage form, dose adjustment, and preparation method are critical to ensuring efficacy and medication safety.
Important Dosage and Administration Information
Valsartan tablets and oral suspension are not interchangeable on a milligram-per-milligram basis. The two dosage forms must not be combined to achieve a total dose. Compared with tablets, the oral suspension results in a 60% higher systemic exposure (AUC) of valsartan.
Recommended Use of Oral Suspension
Pediatric patients 1 to 5 years of age.
Patients older than 5 years who are unable to swallow tablets.
Pediatric patients for whom the calculated dose (mg/kg) does not match available tablet strengths.
Dose adjustment of valsartan may be required when switching between suspension and tablets.
Adult Hypertension
The recommended starting dose is 80 mg or 160 mg once daily (as monotherapy in patients not volume-depleted). Patients requiring greater blood pressure reduction may initiate at a higher dose.
The daily dose range of valsartan is 80 mg to 320 mg, administered once daily.
The antihypertensive effect is generally evident within 2 weeks, with the maximum effect typically achieved after 4 weeks.
If additional blood pressure reduction is needed within the starting dose range, the dose may be increased to a maximum of 320 mg or a diuretic may be added. The addition of a diuretic is more effective than increasing the dose above 80 mg.
Pediatric Hypertension (1 to 16 years of age)
The usual recommended starting dose is 1 mg/kg once daily (total dose not exceeding 40 mg).
In specific cases requiring greater blood pressure reduction, a higher starting dose of 2 mg/kg may be considered.
Dose should be adjusted according to blood pressure response and tolerability, up to a maximum of 4 mg/kg once daily (maximum daily dose 160 mg).
Use is not recommended in children under 1 year of age.
Heart Failure
The recommended starting dose is 40 mg twice daily.
The dose may be titrated upward to 80 mg and 160 mg twice daily, or to the highest dose tolerated by the patient.
Reduction of the dose of concomitant diuretics should be considered.
The maximum daily dose used in clinical trials was 320 mg, administered in divided doses.
Post-Myocardial Infarction
Administration may begin as early as 12 hours after myocardial infarction.
The recommended starting dose is 20 mg twice daily.
The dose may be titrated to 40 mg twice daily within 7 days, then increased to a target maintenance dose of 160 mg twice daily as tolerated.
If symptomatic hypotension or renal dysfunction occurs, dose reduction should be considered.
Valsartan may be used in combination with standard post-infarction therapy, including thrombolytics, aspirin, beta-blockers, and statins.
Missed Dose
If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next dose.
Do not double the dose to make up for a missed one.
