Valsartan
Mechanism :
Valsartan, an angiotensin II receptor antagonist, produces its BP lowering effects by antagonizing angiotensin II-induced vasoconstriction, aldosterone release and renal reabsorption of sodium.
Indication :
Contraindications :
Hypersensitivity; Severe hepatic impairment; Cirrhosis or biliary obstruction; Primary hyperaldosteronism.
Dosing :
<6 years:
Safety and efficacy not established
>6 years:
0.65-1.3 mg/kg/dose twice daily. Increase upto 40 mg/day. Maximum dose: 160 mg/day. In adults, maximum dose is 320 mg/day.
Adverse Effect :
Dizziness, headache, dose-related orthostatic hypotension, rash, angioedema, hyperkalaemia, myalgia, dry cough, back pain, fatigue, GI disturbances, abdominal pain, LFT elevations, increase in BUN and serum creatinine, blood dyscrasias (e.g. neutropenia).
Interaction :
NSAIDs and Ciclosporin: Increased risk of renal impairment and hyperkalaemia with NSAIDs and ciclosporin.
General Anaesthetics, Clozapine, Dopamine agonists and other Antihypertensives: Increased risk of hypotension.
Lithium: Increased risk of lithium toxicity.
Potassium-Sparing Diuretics, Potassium Supplements, ACE Inhibitors, Heparin: Increased risk of hyperkalaemia.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Initial dose 40 mg; titrate according to response |
| <10 | Initial dose 40 mg; titrate according to response |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in GFR<10 mL/min |
| HD | Not dialysed. Dose as in GFR<10 mL/min |
| HDF/High flux | Unknown dialysability. Dose as in GFR<10 mL/min |
| CAV/VVHD | Unlikely to be dialysed. Dose as in GFR=10–20 mL/min |
Hepatic Dose :
Mild to moderate hepatic impairment: Dose adjustment is not necessary but use cautiously as in liver impairment, levels can increase 2 times.
Severe hepatic impairment: Dose may need to be reduced, however guidelines do not specify dose, as it has not been studied.