Hydrochlorothiazide + Valsartan

Hydrochlorothiazide + Valsartan is a combination medicine that helps control high blood pressure. Valsartan is an angiotensin receptor blocker (ARB) that blocks the hormone angiotensin, relaxing blood vessels and allowing blood to flow more smoothly. Hydrochlorothiazide is a diuretic that removes extra water and electrolytes from the body. This combination is effective for treating hypertension, which if left untreated can lead to heart attacks, strokes and kidney failure. It can be taken with or without food, preferably avoiding intake within 4 hours of bedtime to prevent nighttime urination.

• Hypertension (high blood pressure)

Adult Dose (Oral):

• Initial: 1 tablet/day (80-160 mg valsartan + 12.5-25 mg HCTZ)
• May titrate after 1-2 weeks if needed
• Max: Valsartan 320 mg + HCTZ 25 mg daily

Elderly: No initial dosage adjustment necessary

Renal Dose: CrCl <30 mL/min: Not recommended

Common Side Effects:

• Headache
• Dizziness
• Fatigue
• Abdominal pain
• Cough
• Diarrhea
• Nausea
• Hyperkalemia
• Reduced renal function
• Hypotension

Others: Impotence, allergic reactions, dyspnea, constipation, back pain, muscle cramps, rash, anxiety, insomnia, vertigo

Precautions:

• Hydrochlorothiazide + Valsartan may decrease alertness, affect vision or make you feel sleepy and dizzy; do not drive if these symptoms occur
• May cause dehydration; drink plenty of fluids; inform doctor if extreme thirst, very dry mouth or muscle weakness develops
• May cause dizziness; get up slowly when rising from a sitting or lying position
• Not safe during pregnancy and breastfeeding
• Hepatic Impairment: As majority of valsartan is eliminated in bile, caution in mild to moderate hepatic impairment
• Renal Impairment: Dosage reduction or discontinuation may be required with pre-existing renal impairment
• Caution in heart failure and post-myocardial infarction patients

Contraindications:

• Hypersensitivity
• Severe hepatic impairment
• Creatinine clearance <30 mL/min
• Anuria
• Cirrhosis, biliary obstruction
• Refractory hypokalemia, hyponatremia, hypercalcemia, hyperuricemia
• History of gout and uric acid stones
• Untreated Addison's disease
• Pregnancy and lactation

Drug Interactions:

• Other antihypertensives: Increased antihypertensive effect
• Potassium supplements, potassium-sparing diuretics, salt substitutes containing potassium: Monitor potassium levels frequently
• NSAIDs: Reduced antihypertensive effect of valsartan and increased risk of renal impairment
• Lithium: Increased lithium levels; monitor lithium levels
• Alcohol, Barbiturates, Narcotics: May potentiate antihypertensive effect or orthostatic hypotension
• Antidiabetic drugs: Dosage adjustment may be required
• Cholestyramine & Colestipol: Reduced absorption of hydrochlorothiazide

Food Interactions: It is unsafe to consume alcohol with Hydrochlorothiazide + Valsartan.

Use in Pregnancy: Unsafe during pregnancy; in 2nd and 3rd trimester can cause injury or death to fetus; discontinue when pregnancy is detected.

Use in Lactation: It is not known whether valsartan is excreted in human milk; hydrochlorothiazide is excreted in breast milk.

Renal Impairment: CrCl >30 mL/min: Follow usual regimen; loop diuretics preferred in severe renal impairment; not recommended.

Hepatic Impairment: Caution is advised in hepatic impairment.

Overdose: Valsartan: Hypotension and tachycardia; bradycardia may occur; if excessive hypotension occurs, place in supine position and give IV normal saline. Hydrochlorothiazide: Electrolyte depletion (hypokalemia, hypochloremia) and dehydration; hypokalemia with digitalis may accentuate cardiac arrhythmias; symptomatic treatment.