II. Indications
- See Angiotensin Receptor Blocker
- Hypertension
- Congestive Heart Failure
- Post-Myocardial Infarction
- Diabetic Nephropathy (not FDA approved)
III. Contraindications
- See Angiotensin Receptor Blocker
- Age <6 years old
- Creatinine Clearance <30 ml/min
IV. Mechanism
V. Dosing: Adults
-
Hypertension or Diabetic Nephropathy
- Start 80 to 160 mg orally daily
- Maximum 320 mg/day
-
Congestive Heart Failure
- Start 40 mg orally twice daily
- Target 160 mg orally twice daily
- Post-Myocardial Infarction
- Start 20 mg orally twice daily
- Next increase to 40 mg orally twice daily in first week
- Target 160 mg orally twice daily
VI. Dosing: Children (age over 6 years)
- Start 1.3 mg/kg orally divided once to twice daily
- Maximum 2.7 mg/kg/day up to 160 mg/day
VII. Medications: Combinations
- Amlodipine and Valsartan (Exforge)
- Hydrochlorothiazide and Valsartan (Diovan HCT)
-
Sacubitril and Valsartan (Entresto)
- Indicated in Systolic Dysfunction (consider as an alternative to ACE Inhibitor or mono Angiotensin Receptor Blocker)
- Sacubitril (Neprilysin Inhibitor) increases vasodilation and Sodium excretion
- Risk of Hypotension (Number needed to harm 21)
- Risk of Angioedema (Number needed to harm 200)
- See Systolic Dysfunction for dosing and references
VIII. Adverse Effects
IX. Safety
- See Angiotensin Receptor Blocker
- Pregnancy Category X
- Unknown Safety in Lactation
X. Resources
XI. References
- (2018) Presc Lett, Resource #340901, Angiotensin Receptor Blocker (ARB) Antihypertensive Dose Comparison
- (2020) Med Lett Drugs Ther 62(1598): 73-80
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 66-7
- Hamilton (2020) Tarascon Pocket Pharmacopoeia