Hypertension: The recommended starting dose of valsartan is 80 mg once daily. The antihypertensive effect is substantially present within 2 weeks, and maximal effects are attained within 4 weeks. In some patients whose blood pressure is not adequately controlled, the dose can be increased to 160 mg and to a maximum of 320 mg.
Valsartan may also be administered with other antihypertensive agents. The addition of a diuretic such as hydrochlorothiazide will decrease blood pressure even further in these patients.
Recent Myocardial Infarction: In clinically stable patients, therapy may be initiated as early as 12 hours after a myocardial infarction. After an initial dose of 20 mg twice daily, valsartan should be titrated to 40 mg, 80 mg, and 160 mg twice daily over the next few weeks. The starting dose is provided by the 40 mg divisible tablet.
The target maximum dose is 160 mg twice daily. In general, it is recommended that patients achieve a dose level of 80 mg twice daily by two weeks after treatment initiation and that the target maximum dose, 160 mg twice daily, be achieved by three months, based on the patient's tolerability. If symptomatic hypotension or renal dysfunction occur, consideration should be given to a dosage reduction.
Valsartan may be used in patients treated with other post-myocardial infarction therapies, e.g. thrombolytics, acetylsalicylic acid, beta blockers, statins, and diuretics. The combination with ACE inhibitors is not recommended (see Pharmacology: Pharmacodynamics under Actions and Precautions).
Evaluation of post-myocardial infarction patients should always include assessment of renal function.
Heart Failure: The recommended starting dose of valsartan is 40 mg twice daily. Uptitration to 80 mg and 160 mg twice daily should be done at intervals of at least two weeks to the highest dose, as tolerated by the patient. Consideration should be given to reducing the dose of concomitant diuretics. The maximum daily dose administered in clinical trials is 320 mg in divided doses.
Valsartan may be administered with other heart failure therapies. However, the triple combination of an ACE inhibitor, a beta blocker and valsartan is not recommended (see Pharmacology: Pharmacodynamics under Actions and Precautions).
Evaluation of patients with heart failure should always include assessment of renal function.
Additional Information on Special Populations: Elderly: No dose adjustment is required in elderly patients.
Renal Impairment: No dosage adjustment is required for patients with a creatinine clearance >10 mL/min (see Pharmacology: Pharmacokinetics under Actions and Precautions).
Hepatic Impairment: In patients with mild to moderate hepatic impairment without cholestasis, the dose of valsartan should not exceed 80 mg. Valsartan Sandoz is contraindicated in patients with severe hepatic impairment and in patients with cholestasis (see Pharmacology: Pharmacokinetics under Actions, Contraindications and Precautions).
Pediatric Patients: Valsartan is not recommended for use in children below the age of 18 years due to a lack of data on safety and efficacy.
Administration: Valsartan (Tareg) may be taken independently of a meal and should be administered with water.