Valsartan + Hydrochlorothiazide
Hydrochlorothiazide is a thiazide diuretic. Thiazides affect the renal tubular mechanisms of electrolyte reabsorption, directly increasing excretion of sodium and chloride in approximately equivalent amounts. Indirectly, the diuretic action of Hydrochlorothiazide reduces plasma volume, with consequent increases in plasma renin activity, increases in aldosterone secretion, increases in urinary potassium loss, and decreases in serum potassium. The renin-aldosterone link is mediated by angiotensin II, so co-administration of anangiotensin converting enzyme (ACE) inhibitor tends to reverse the potassium loss associated with these diuretics.
Dosage & Administration
For Elderly: No initial dosage adjustment is necessary for elderly patients.
Pediatric use: Safety and effectiveness in pediatric patients have not been established.
- Diuretics: Patient on diuretics may occasionally experience excessive reduction in blood pressure after initiation of therapy with Valsartan. No drug interaction of clinical significance has been identified with thiazide diuretics.
- Agents increasing Serum Potassium: Since Valsartan decreases the production of aldosterone, potassium supplements or salt containing potassium substitutes may lead to hyperkalemia.
- Lithium Salts: As with other drugs which eliminate sodium, lithium clearance may be reduced. Therefore, serum lithium levels should be monitored carefully if lithium salts are to be administered.
- Other drugs showing interaction are Warfarin, Digoxin.
- When administered concurrently, the following drugs may interact with thiazide diuretics: alcohol, barbiturates, or narcotics may potentiate antihypertensive effect or orthostatic hypotension may occur.
- Antidiabetic drugs (oral agents and insulin): dosage adjustment of the antidiabetic drug may be required.
- Other antihypertensive drugs give additive effect.
- Cholestyramine and colestipol resins: absorption of Hydrochlorothiazide is impaired in the presence of anionic exchange resins.
Pregnancy & Lactation
Nursing mothers: It is not known whether Valsartan is excreted in human milk. Hydrochlorothiazide is excreted in breast milk.
Impaired Renal Function: Dosage reduction or discontinuation may be required with patients having pre-existing renal impairment because thiazides may precipitate azotemia.
Heart Failure and Myocardial Infarction: Caution should be observed when initiating therapy in patients with heart failure and post-myocardial infarction patients.
Hydrochlorothiazide: The most common signs and symptoms observed are those caused by electrolyte depletion (hypokalemia, hypochloremia, and dehydration) resulting from excessive diuresis. if digitalis has also been administered with it, hypokalemia, may accentuate cardiac arrhythmias. The degree to which Hydrochlorothiazide is removed by hemodialysis has not been established.
Use in Special Population
Use in patients with Hepatic Impairment: Care should be taken in patient with hepatic impairment.