Indications for DIOVAN HCT:
Take once daily. Add-on or initial therapy and not volume-depleted: initially 160mg/12.5mg; may increase after 1–2 weeks up to max 320mg/25mg. Maximum effects within 2–4 weeks after dose change. May be substituted for the titrated components.
Anuria. Sulfonamide allergy. Concomitant aliskiren in patients with diabetes.
Fetal toxicity may develop; discontinue if pregnancy detected. Intravascular volume depletion; do not use as initial therapy. Correct salt/volume depletion before starting, or monitor closely. Diabetes. Gout. Asthma. Hypercalcemia. Severe CHF. Renal artery stenosis. SLE. Acute myopia. Secondary angle-closure glaucoma. Monitor electrolytes. Liver disease. Severe renal impairment (CrCl ≤30mL/min): not established. Neonates. Pregnancy (Cat.D); avoid. Nursing mothers: not recommended.
Angiotensin II receptor blocker (ARB) + thiazide diuretic.
See Contraindications. Monitor for hyperkalemia with K+ supplements, K+ sparing diuretics, K+ containing salt substitutes. Antagonized by cholestyramine, colestipol resins. Dual inhibition of the renin-angiotensin system with ARBs, ACEIs, or aliskiren may increase risk of hypotension, hyperkalemia, renal function changes; monitor closely, in general, avoid combined use of RAS inhibitors. Concomitant aliskiren in renal impairment (CrCl <60mL/min): not recommended. May be antagonized by, and renal toxicity potentiated by NSAIDs, including selective COX-2 inhibitors (monitor renal function periodically in elderly and/or volume-depleted). Orthostatic hypotension may be potentiated by alcohol, barbiturates, narcotics, antihypertensives. May be potentiated by inhibitors of OATP1B1 (eg, rifampin, cyclosporine) or MRP2 (eg, ritonavir). Potentiates nondepolarizing muscle relaxants. Adjust antidiabetic, antigout medications. Hyperuricemia may be potentiated by cyclosporine. May increase toxicity of digitalis, lithium (monitor). Possible symptomatic hyponatremia with carbamazepine.
Headache, dizziness, nasopharyngitis, fatigue, cough, diarrhea, orthostatic hypotension, electrolyte disturbances (eg, hypokalemia, hyponatremia, hypomagnesemia), hyperuricemia, increased serum cholesterol or triglycerides; rare: rhabdomyolysis.
Valsartan: fecal, renal. HCTZ: renal.