Adult Dosing
Initial therapy
- Start: 12.5 mg/160 mg PO qd; increase to max: 25 mg/320 mg PO qd PRN after 1-2 wks
Replacement or add on therapy
- For replacement therapy start same doses of both components; start combination at lower dose of either hydrochlorothiazide or valsartan if receiving prior maximum tolerable dose of that component as monotherapy; may increase dose after 3-4wks
- Max: 25 mg/320 mg PO qd
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- 60-90 or 30-60 mL/min: No dose adjustments
30 mL/min: Dose adjustment not defined
Hepatic Dose Adjustment
- Mild to moderate impairment: No dose adjustments
- Severe impairment: Dose adjustment not defined
- As drugs directly acting on the renin-angiotensin system can cause fatal/neonatal morbidity/mortality, therapy should be suspended as soon as possible when pregnancy is detected [US Black Box Warning]
- Hydrochlorothiazide may precipitate azotemia in patients with renal disease. Therefore use with caution in severe renal disease. Cumulative effects of the drug may develop in patients with impaired renal function
- Use with caution in patients with impaired hepatic function or progressive liver disease, since minor alterations of fluid and electrolyte balance may precipitate hepatic coma
- Use with caution in patients with or without a history of allergy or bronchial asthma to avoid sensitivity reactions
- Increased risk of lithium toxicity reported, hence monitor serum lithium concentrations during concurrent use
- Therapy may cause exacerbation or activation of systemic lupus erythematosus
- Carefully monitor fluid or electrolyte imbalance during the therapy
- Hydrochlorothiazide associated hypokalemia may be avoided or treated by use of potassium sparing diuretics or potassium supplements such as foods with a high potassium content
- Carefully adjust dosage of insulin or oral hypoglycemic agents when administering hydrochlorothiazide in diabetic patients
- Hydrochlorothiazide may increase the urinary excretion of magnesium; this may result in hypomagnesemia
- Suspend hydrochlorothiazide before carrying out tests for parathyroid function because marked hypercalcemia may be evidence of hidden hyperparathyroidism
- Hydrochlorothiazide may cause increases in cholesterol and triglyceride levels
- Hypotension may occur in heart failure or post-MI patients. Use with caution when initiating therapy.
- Symptomatic hypotension may occur after initiation of valsartan therapy in patients with intravascular volume depletion (eg, those treated with diuretics). Correct these conditions prior to starting therapy with valsartan or start treatment under medical supervision
- Patients with renal artery stenosis may experience acute renal failure. In patients with severe heart failure whose renal function may depend on the activity of the renin-angiotensin-aldosterone system, treatment may be associated with oliguria and/or progressive azotemia and (rarely) with acute renal failure and/or death. Use with caution in severe CHF
Cautions: Use cautiously in
- Severe renal impairment
- Hepatic impairment
- Progressive hepatic disease
- Electrolyte abnormalities
- Hyponatremia
- Volume depletion
- Post-sympathectomy
- Diabetes mellitus
- Seizure disorder
- Pregnancy near term
- Gestational HTN
- SLE
- Hx of gout
- Hx of pancreatitis
- Elderly patients
Pregnancy Category:D
Breastfeeding: Safety unknown. Hydrochlorothiazide doses of 50 mg daily or less are acceptable during lactation. Intense diuresis with large doses may decrease breastmilk production. Valsartan: No data available for the use of valsartan during breastfeeding. An alternate drug may be preferred, especially while nursing a newborn or preterm infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 20 May 2011). Hydrochlorothiazide maternal medication usually compatible with breastfeeding, no observable change was seen in the nursing infant while the mother was ingesting the compound. This information is based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T6 last accessed 20 May 2011). Due to the potential for serious adverse reactions in nursing infants, manufacturer recommends discontinuation of nursing or discontinuation of drug, taking into account the importance of the drug to the mother.
US Trade Name(s)
US Availability
hydrochlorothiazide/valsartan (generic)
- TABS
- 12.5 mg/80 mg
- 12.5 mg/160 mg
- 25 mg/160 mg
- 12.5 mg/320 mg
- 25 mg/320 mg
Diovan HCT (hydrochlorothiazide/valsartan)
- TABS:
- 12.5 mg/80 mg
- 12.5 mg/160 mg
- 25 mg/160 mg
- 12.5 mg/320 mg
- 25 mg/320 mg
Canadian Trade Name(s)
Canadian Availability
hydrochlorothiazide/valsartan (generic)
- TABS:
- 12.5 mg/80 mg
- 12.5 mg/160 mg
- 25 mg/160 mg
- 12.5 mg/320 mg
- 25 mg/320 mg
Diovan HCT (hydrochlorothiazide/valsartan)
- TABS:
- 12.5 mg/80 mg
- 12.5 mg/160 mg
- 25 mg/160 mg
- 12.5 mg/320 mg
- 25 mg/320 mg
UK Trade Name(s)
UK Availability
Co-Diovan
- TABS:
- 12.5 mg/80 mg
- 12.5 mg/160 mg
- 25 mg/160 mg
Australian Trade Name(s)
Australian Availability
Co-Diovan
- TABS:
- 12.5 mg/80 mg
- 12.5 mg/160 mg
- 25 mg/160 mg
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Diovan HCT 80-12.5 MG TABS [Bottle] (NOVARTIS)
30 mg = $110.99
90 mg = $310.97 - Diovan HCT 320-12.5 MG TABS [Bottle] (NOVARTIS)
30 mg = $142.99
90 mg = $409.99 - Diovan HCT 160-25 MG TABS [Bottle] (NOVARTIS)
30 mg = $130.99
90 mg = $371.97 - Diovan HCT 160-12.5 MG TABS [Bottle] (NOVARTIS)
30 mg = $117.99
90 mg = $331.97 - Diovan HCT 320-25 MG TABS [Bottle] (NOVARTIS)
30 mg = $168.99
90 mg = $485.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.