General Considerations: The side effects of valsartan are generally rare and appear independent of dose. Those of hydrochlorothiazide are a mixture of dose-dependent (primarily hypokalemia) and dose-independent phenomena (e.g., pancreatitis), the former much more common than the latter. Dose once-daily. Maximum antihypertensive effects are attained within 2 to 4 weeks after a change in dose.
Valazyd H may be administered with or without food. Valazyd H may be administered with other antihypertensive agents.
Elderly patients: No initial dosage adjustment is required for elderly patients.
Renal impairment: The usual regimens of therapy with Valazyd H may be followed as long as the patient's creatinine clearance is > 30 mL/min. In patients with more severe renal impairment, loop diuretics are preferred to thiazides, so Valazyd H is not recommended.
Hepatic impairment: Care should be exercised with dosing of Valazyd H in patients with hepatic impairment. Start with a low dose and titrate slowly in patients with hepatic impairment.
Add-On Therapy: A patient whose blood pressure is not adequately controlled with valsartan (or another ARB) alone or hydrochlorothiazide alone may be switched to combination therapy with Valazyd H.
A patient who experiences dose-limiting adverse reactions on either component alone may be switched to Valazyd H containing a lower dose of that component in combination with the other to achieve similar blood pressure reductions. The clinical response to Valazyd H should be subsequently evaluated and if blood pressure remains uncontrolled after 3 to 4 weeks of therapy, the dose may be titrated up to a maximum of 320/25 mg.
Replacement Therapy: Valazyd H may be substituted for the titrated components.
Initial Therapy: The usual starting dose is Valazyd H 160/12.5 mg once daily. The dosage can be increased after 1 to 2 weeks of therapy to a maximum of one 320/25 mg tablet once daily as needed to control blood pressure. Valazyd H is not recommended as initial therapy in patients with intravascular volume depletion.