Valsartan is given orally. After a dose the hypotensive effect occurs within 2 hours, reaches a peak within 4 to 6 hours, and persists for over 24 hours. The maximum hypotensive effect is achieved within 2 to 4 weeks.
In hypertension, valsartan is given in an initial dose of 80 mg once daily. This may be increased, if necessary, to 160 mg once daily; the maximum dose is 320mg once daily.
In heart failure, valsartan is given in an initial dose of 40 mg twice daily. The dose should be increased, as tolerated, to 160 mg twice daily.
In patients who have had myocardial infarction, valsartan may be started as early as 12 hours after the infarction in clinically stable patients, in an initial dose of 20 twice daily; the dose may be doubled at intervals over the next few weeks up to 160 mg twine daily if tolerated.
Valsartan should be used with caution in patients with renal or hepatic impairment and dose reduction may be required in the latter.
Administration in children: Valsartan may be used for hypertension in children aged 6 to 16 years. US licensed product information recommends an initial dose of 1.3 mg/kg once daily (up to a maximum of 40 mg), The dose should be adjusted ac cording to response, but doses above 2.7 mg/kg daily have not been studied. A suspension formulation may be used (but exposure to valsartan may be higher with the suspension than with tablets. There is no experience with valsartan in children with renal impairment (creatinine clearance below 30 mL/minute per 1.73m2 and it should therefore not be used in such children.
Administration in hepatic impairment: The elimination of valsartan may be reduced in patients with hepatic impairment or biliary obstruction and it should be used with caution, if at all, in such patients. In the UK, valsartan is contra-indicated in patients with severe hepatic impairment, cirrhosis, or biliary obstruction, In mild to moderate hepatic impairment, the total daily dote should not exceed 80mg.