Valsartan

Indications

Valsartan is used for: Heart failure, Hypertension, Post myocardial infarction

Adult Dose

Oral Hypertension Adult: Initially, 80 mg once daily, may be increased to 160 mg once daily if needed. Max: 320 mg once daily. Heart failure Adult: Initially, 40 mg bid, may be increased to 160 mg bid if tolerated. Post myocardial infarction Adult: Start as early as 12 hr after MI in stable patients at an initial dose of 20 mg bid, doubled at intervals over a few wk up to 160 mg bid if tolerated. Elderly: No dosage adjustment needed. Hepatic impairment: Mild to moderate: Max: 80 mg once daily. Severe: Contraindicated.

Child Dose

Oral Hypertension Child: As tab: >6 yr <35 kg: Initially, 40 mg once daily. Max: 80 mg once daily; 35-80 kg: Initially, 80 mg once daily. Max: 160 mg once daily; >80 kg: Initially, 80 mg once daily. Max: 320 mg once daily.

Renal Dose

Renal impairment CrCl >30 mL/min: No dose adjustment necessary in adults CrCl <30 mL/min: Use with caution in adults; not studied in children

Administration

May be taken with or without food.

Contra Indications

Hypersensitivity; severe hepatic impairment, cirrhosis or biliary obstruction; primary hyperaldosteronism. Pregnancy (2nd and 3rd trimesters) and lactation.

Precautions

Patients w/ renal artery stenosis, heart failure, aortic or mitral stenosis, severe Na and/or volume depletion. Renal and mild to moderate hepatic impairment. Lactation. Monitoring Parameters Monitor BP, electrolytes, renal function. Monitor serum K levels every dose increment and periodically thereafter.

Pregnancy-Lactation

Interactions

May antagonise hypotensive effects and increase the risk of renal impairment w/ NSAIDs. Increased risk of hyperkalaemia w/ K-sparing diuretics, K supplements or K-containing salt substitutes. Potentially Fatal: Increased risk of hypotension, hyperkalemia and changes in renal function (including acute renal failure) when used w/ aliskiren in patients w/ diabetes and renal impairment (GFR <60 mL/min).

Adverse Effects

Side effects of Valsartan : >10% Dizziness (17%; heart failure),Increased blood urea nitrogen (BUN; 17%) 1-10% Hyperkalemia (4-10%),Dizziness (2-8%; hypertension),Hypotension (1-7%; heart failure),Fatigue (3%),Viral infection (3%),Neutropenia (2%),Syncope (>1%),Upper abdominal pain (>1%),Vertigo (>1%) Frequency Not Defined Headache,Cough (rare) Potentially Fatal: Blood dyscrasias (e.g. neutropenia).

Mechanism of Action

Valsartan, an angiotensin II type 1 (AT1) receptor antagonist, produces its BP lowering effects by inhibiting angiotensin II-induced vasoconstriction, aldosterone release and renal reabsorption of Na.