Valsartan
CLINICAL USE
Angiotensin-II antagonist: Hypertension Left ventricular dysfunction Myocardial infarction with left ventricular failure
DOSE IN NORMAL RENAL FUNCTION
40–320 mg daily Myocardial infarction: 20–160 mg twice daily
PHARMACOKINETICS
Molecular weight : 435.5 %Protein binding : 94–97 %Excreted unchanged in urine : 13 Volume of distribution (L/kg) : 17 litres half-life – normal/ESRD (hrs) : 5–9/Unchanged DOSE IN RENAL IMPAIRMENT
GFR (mL/MIN)
20 to 50 : Dose as in normal renal function 10 to 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 to 20 mL/min IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs Anaesthetics: enhanced hypotensive effect Analgesics: antagonism of hypotensive effect and increased risk of renal impairment with NSAIDs; hyperkalaemia with ketorolac and other NSAIDs Ciclosporin: increased risk of hyperkalaemia and nephrotoxicity Diuretics: enhanced hypotensive effect; hyperkalaemia with potassium-sparing diuretics Epoetin: increased risk of hyperkalaemia; antagonism of hypotensive effect Lithium: reduced excretion (possibility of enhanced lithium toxicity) Potassium salts: increased risk of hyperkalaemia Tacrolimus: increased risk of hyperkalaemia and nephrotoxicity ADMINISTRATION
Reconstition
– Route
Oral Rate of Administration
– Comments
– OTHER INFORMATION
Side effects (e.g. hyperkalaemia, metabolic acidosis) are more common in patients with impaired renal function Close monitoring of renal function during therapy is necessary in those with renal insufficiency Renal failure has been reported in association with angiotensin-II antagonists in patients with renal artery stenosis, post renal transplant, and in those with severe congestive heart failure .
See how to identify renal failure stages according to GFR calculation
See how to diagnose irreversible renal disease
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