The National Prescribing Service Limited (Australia) issues a publication called NPS RADAR. In this issue valsartan (Diovan) is reviewed, this is the summary:
- Valsartan reduces blood pressure to a similar extent as other angiotensin II-receptor antagonists.
- If blood pressure is not controlled by valsartan 160 mg, add a second drug rather than increasing the dose to 320 mg. Increasing the dose from 160 mg to 320 mg provides marginal additional blood pressure reduction.
- Establish the effective dose using individual drugs before prescribing the appropriate combination.
- Check electrolytes and renal function before and 1–2 weeks after starting valsartan, after each dose increment or if changed clinical circumstances are likely to worsen renal function (e.g. dehydration).
- Avoid angiotensin II-receptor blockers (including valsartan) in combination with a nonsteroidal anti-inflammatory drug and a diuretic (including hydrochlorothiazide) — particularly in elderly people or people with pre-existing renal impairment — because combining these 3 drug classes increases the risk of acute renal failure.
In a related topic, Pharmamotion also features PowerPoint presentations on drug therapy for heart failure.