OralHypertensionAdult: Per combination tablet contains valsartan/hydrochlorothiazide: 80/12.5 mg; 160/12.5 mg; 160/25 mg; 320/12.5 mg; 320/25 mg: Initially, 80/12.5 mg once daily, titrate dose gradually according to response, up to 320/25 mg.
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| CrCl | Dosage |
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| <30 | Not recommended. |
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Hypersensitivity to valsartan, hydrochlorothiazide or sulphonamides. Severe hepatic impairment, creatinine clearance <30ml/min, anuria, cirrhosis, biliary obstruction, conditions where there is increased potassium loss (e.g. salt losing nephropathies and pre-renal impairment of kidney function), refractory hypokalaemia, hyponatraemia, hypercalcaemia, hyperuricaemia, history of gout and uric acid stones, untreated Addison's disease. Pregnancy and lactation.
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DM, postsympathectomy patients. May exacerbate SLE. Monitor serum potassium regularly. Observe for signs of fluid or electrolyte imbalance. Discontinue before testing for parathyroid function. May affect ability to drive or operate machinery. Elderly.
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Headache, asthenia, fatigue, dizziness, somnolence, insomnia, orthostatic hypotension, paraesthesia, nasopharyngitis, tachycardia, palpitations, tinnitus, vertigo, dyspepsia, diarrhoea, flatulence, dry mouth, nausea, vomiting, abdominal pain, peripheral oedema, pyrexia, increased BUN, elevated LFT, anxiety, erectile dysfunction, glucose intolerance, increased serum cholesterol, triglycerides, uric acid. Electrolyte imbalances e.g. hypomagnesaemia, hypercalcaemia, hyponatraemia, hypochloraemic alkalosis.
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Symptoms: Hypotension, tachycardia, bradycardia, circulatory collapse, electrolyte abnormalities (e.g. hypokalaemia, hypochloremia, hyponatremia, dehydration). Management: Treatment is symptomatic and supportive. Effectiveness of haemodialysis is unknown.
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Increased antihypertensive effect with other antihypertensive drugs. Monitor potassium frequently if used with potassium supplements, potassium-sparing diuretics, salt substitutes containing potassium, or drugs that may affect potassium levels (e.g. heparin, ciclosporin, drospirenone, amphotericin, corticosteroids, carbenoxolone). Reduced antihypertensive effect of valsartan and increased risk of renal impairment with NSAIDs. May reduce renal clearance of cytotoxic drugs (e.g. cyclophosphamide, methotrexate). Increased serum calcium with vitamin D or calcium salts.
Potentially Fatal: Increased lithium levels with valsartan, monitor lithium levels. Increased risk of cardiac arrhythmia with dofetilide, avoid use.
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Thiazides may decrease serum protein bound iodine levels.
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Description: Valsartan is an angiotensin II receptor antagonist and reduces blood pressure by blocking the vasoconstrictive and aldosterone-secreting effects of angiotensin II. Hydrochlorothiazide is a thiazide diuretic.
Onset: Hyopotensive effect of valsartan: 2hr. Diuresis effect of hydrochlorothiazide: 2 hr.
Duration: Hypotensive effect of valsartan: 24 hr. Diuresis effect of hydrochlorothiazide: 6-12 hr.
Pharmacokinetics:
Absorption: Valsartan: Rapidly absorbed, bioavailability 23%, peak plasma concentration occur 2-4 hr. Hydrochlorothiazide: Rapidly absorbed, bioavailability: 65-70%.
Distribution: Valsartan: Protein binding 94-97%, mainly to serum albumin, volume of distribution: 17 L. Hydrochlorothiazide: Preferentially bound to red blood cells, crosses placenta and excreted into breast milk.
Metabolism: Valsartan: Not significantly metabolised.
Excretion: Valsartan: Excreted mainly as unchanged drug in faeces (70%) and urine (30%), terminal half life 5-9 hr. Hydrochlorthiazide: Excreted mainly unchanged in urine, plasma half life 5-15 hr.
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