Diovan

Alone or in combination w/ other antihypertensive agents for the treatment of HTN. Treatment of heart failure (NYHA class II-IV). Reduction of CV mortality in clinically stable patients w/ left ventricular failure or dysfunction following MI.

HTN Adult Initially 80 mg or 160 mg once daily, may be increased to a max of 320 mg or a diuretic may be added. Ped patient 6-16 yr Initially 1.3 mg/kg once daily (up to 40 mg total). Adjust dose according to BP response. Heart failure Initially 40 mg bd. Uptitration to 80 mg & 160 mg bd should be done to the highest dose, as tolerated by the patient. Max dose: 320 mg daily in divided doses. Post-MI Initially 20 mg bd, may be initiated as early as 12 hr after MI. Uptitration to 40 mg bd may be done w/in 7 days, w/ subsequent titrations to target maintenance dose of 160 mg bd, as tolerated by the patient.

May be taken with or without food.

Hypersensitivity. Concomitant use w/ aliskiren-containing products in patients w/ DM or renal impairment (GFR <60 mL/min/1.73 m²).

Symptomatic hypotension may occur in patients w/ activated renin-angiotensin system eg, vol- &/or salt-depleted patients receiving high doses of diuretics. Observe caution when initiating therapy in heart failure or post-MI patients. Periodically monitor renal function in patients whose renal function may depend in part on the activity of the renin-angiotensin system (eg, patients w/ renal artery stenosis, CKD, severe CHF, or vol depletion). Risk of hyperkalemia. Dual blockade of the renin-angiotensin-aldosterone system through the combined use of ACE inhibitors, ARBs or aliskiren is not recommended. ACE inhibitors & ARBs should not be used concomitantly in patients w/ diabetic nephropathy. Safety & effectiveness in patients w/ severe renal impairment (CrCl ≤30 mL/min) have not been established. Caution in patients w/ severe liver disease. Discontinue use as soon as possible when pregnancy is detected. Potential risk to the fetus. Discontinue nursing or discontinue Diovan therapy. Doses >2.7 mg/kg once daily (up to 160 mg) have not been studied in ped patients 6-16 yr. Not recommended for ped patients <6 yr.

Headache, dizziness, viral infection, fatigue, abdominal pain, hyperkalemia, hypotension, diarrhea, arthralgia, back pain, cough, renal dysfunction.

Increased systemic exposure w/ OATP1B1 inhibitors (eg, rifampin, cyclosporine) or MRP2 inhibitors (eg, ritonavir). Concomitant use w/ other agents that block the renin-angiotensin system, K-sparing diuretics (eg, spironolactone, triamterene, amiloride), K supplements, K-containing salt substitutes, or other drugs that may increase K levels (eg, heparin) may lead to increases in serum K, & increases in serum creatinine in heart failure patients. Co-administration w/ NSAIDs including selective COX-2 inhibitors may result in deterioration of renal function (including possible acute renal failure) in elderly patients, vol-depleted patients (including those on diuretic therapy), or patients w/ compromised renal function. Attenuated antihypertensive effect w/ NSAIDs including selective COX-2 inhibitors. Reversible increases in serum conc & toxicity of lithium. Combined use of ACE inhibitors, ARBs or aliskiren is associated w/ higher frequency of adverse events eg, hypotension, hyperkalaemia & decreased renal function (including acute renal failure).

Angiotensin II Antagonists

C09CA03 - valsartan ; Belongs to the class of angiotensin II receptor blockers (ARBs). Used in the treatment of cardiovascular disease.

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