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Valsartan

Pronunciation

Class: Angiotensin II Receptor Antagonists
VA Class: CV805
Chemical Name: N-(1-Oxopentyl)-N-[[2′-(1H-tetrazol-5-yl) [1,1′-biphenyl]-4-yl]methyl)]-l-valine
Molecular Formula: C24H29N5O3
CAS Number: 137862-53-4
Brands: Diovan, Diovan HCT, Exforge (combination)

Warning(s)

  • May cause fetal and neonatal morbidity and mortality if used during pregnancy.1 37 114 115 116 (See Fetal/Neonatal Morbidity and Mortality under Cautions.)

  • If pregnancy is detected, discontinue as soon as possible.1 37 115 116

Introduction

Valsartan is an angiotensin II type 1 (AT1) receptor antagonist.1 2 3 4 5 6 7 8 9 10 37 116

Uses for Valsartan

Hypertension

Valsartan is used for management of hypertension (alone or in combination with other classes of antihypertensive agents);1 2 3 4 5 6 8 9 37 116 500 may be used in fixed combination with amlodipine or hydrochlorothiazide when such combined therapy is indicated.37 116

Angiotensin II receptor antagonists are recommended as one of several preferred agents for the initial management of hypertension; other options include ACE inhibitors, calcium-channel blockers, and thiazide diuretics.501 502 503 504 While there may be individual differences with respect to specific outcomes, these antihypertensive drug classes all produce comparable effects on overall mortality and cardiovascular, cerebrovascular, and renal outcomes.501 502 503 504 Individualize choice of therapy; consider patient characteristics (e.g., age, ethnicity/race, comorbidities, cardiovascular risk) as well as drug-related factors (e.g., ease of administration, availability, adverse effects, cost).500 501 502 503 504 515

Angiotensin II receptor antagonists or ACE inhibitors may be preferred in hypertensive patients with diabetes mellitus or chronic kidney disease; angiotensin II receptor antagonists also may be preferred, as an alternative to ACE inhibitors, in hypertensive patients with heart failure or ischemic heart disease and/or post-MI.500 501 502 504 520 523 524 527 534 535 536 543

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Black hypertensive patients generally tend to respond better to monotherapy with calcium-channel blockers or thiazide diuretics than to angiotensin II receptor antagonists.500 501 504 However, diminished response to an angiotensin II receptor antagonist is largely eliminated when administered concomitantly with a calcium-channel blocker or thiazide diuretic.500 504

The optimum BP threshold for initiating antihypertensive drug therapy is controversial.501 504 505 506 507 508 515 523 530 Further study needed to determine optimum BP thresholds/goals; individualize treatment decisions.501 503 507 515 526 530

JNC 7 recommends initiation of drug therapy in all patients with uncomplicated hypertension and BP ≥140/90 mm Hg;500 JNC 8 panel recommends SBP threshold of 150 mm Hg for patients ≥60 years of age.501 Although many experts agree that SBP goal of <150 mm Hg may be appropriate for patients ≥80 years of age,502 504 505 530 application of this goal to those ≥60 years of age is controversial, especially for those at higher cardiovascular risk.501 502 505 506 508 511 515

In the past, initial antihypertensive drug therapy was recommended for patients with diabetes mellitus or chronic kidney disease who had BP ≥130/80 mm Hg;500 503 current hypertension management guidelines generally recommend a BP threshold of 140/90 mm Hg for these individuals (same as for the general population of patients without these conditions), although a goal of <130/80 mm Hg may still be considered.501 502 503 504 520 530 535 536 541

Heart Failure

Valsartan is used in the management of heart failure.1

Because of their established benefits, ACE inhibitors are the preferred drugs for inhibition of the renin-angiotensin system in patients with heart failure and reduced left ventricular ejection fraction (LVEF); angiotensin II receptor antagonists may be used as an alternative in those intolerant of ACE inhibitors.524 528

No additional therapeutic benefit when used as combination therapy with an ACE inhibitor.1

Heart Failure or Left Ventricular Dysfunction after Acute MI

Valsartan is used to reduce the risk of cardiovascular mortality in clinically stable patients who have demonstrated clinical signs of heart failure or left ventricular dysfunction following MI.1 110 111

Most experts state that angiotensin II receptor antagonists should be used only in those intolerant of ACE inhibitors.110 111

Valsartan may be given with other standard post-MI therapy (e.g., thrombolytics, aspirin, β-adrenergic blocking agents, hydroxymethylglutaryl-CoA [HMG-CoA] reductase inhibitors [statins]).1

Diabetic Nephropathy

A recommended agent in the management of patients with diabetes mellitus and persistent albuminuria who have modestly elevated (30–300 mg/24 hours) or higher (>300 mg/24 hours) levels of urinary albumin excretion; slows rate of progression of renal disease in such patients.59 60 61 62 63 520 535 536

Valsartan Dosage and Administration

General

BP Monitoring and Treatment Goals

  • Carefully monitor BP during initial titration or subsequent upward adjustment in dosage.500 501

  • When available, use evidence-based dosing information (i.e., dosages shown in randomized controlled trials to reduce complications of hypertension) to determine target dosages; target dosages usually can be achieved within 2–4 weeks but may take up to several months.501

  • If adequate BP response not achieved with a single antihypertensive agent, add a second drug with demonstrated benefit; if goal BP still not achieved with optimal dosages of 2 antihypertensive agents, add a third drug.501 May maximize dosage of the first drug before adding a second drug, or add a second drug before maximizing dosage of the initial drug.501

  • Consider initiating antihypertensive therapy with a combination of drugs if patient's BP exceeds goal BP by >20/10 mm Hg.500 501 503 504

  • Goal is to achieve and maintain optimal control of BP; individualize specific target BP based on consideration of multiple factors, including patient age and comorbidities, and currently available evidence from clinical studies.500 501 (See Hypertension under Uses.)

Administration

Oral Administration

Administer valsartan orally once or twice daily without regard to meals.1 9 37

Administer valsartan as extemporaneously prepared oral suspension in pediatric patients unable to swallow tablets or in those for whom the calculated daily dosage does not correspond to the available tablet strengths.1

Reconstitution

Preparation of extemporaneous suspension containing valsartan 4 mg/mL: Add 80 mL of suspending vehicle (e.g., Ora-Plus) to an amber glass bottle containing 8 valsartan 80-mg tablets; shake the contents for ≥2 minutes.1 Allow concentrated suspension to stand for ≥1 hour, then shake for ≥1 additional minute.1 Dilute the concentrated suspension with 80 mL of sweetening vehicle (e.g., Ora-Sweet SF); shake the contents for ≥10 seconds.1 Shake suspension for ≥10 seconds before dispensing each dose.1

Dosage

Pediatric Patients

Hypertension
Oral

Children 6–16 years of age: Initially, valsartan 1.3 mg/kg (up to 40 mg) once daily.1 Adjust dosage according to patient response.1 Dosages >2.7 mg/kg (up to 160 mg) once daily have not been studied in children.1

May need to increase dosage when converting from extemporaneously prepared suspension to oral tablet, since exposure to valsartan with the suspension is 1.6 times greater than with the tablet.1

Adults

Hypertension
Valsartan Therapy
Oral

JNC 8 expert panel recommends initial dosage of 40–80 mg once daily and target dosage of 160–320 mg once daily based on dosages used in randomized controlled studies.501

Manufacturer recommends initial dosage of 80 or 160 mg once daily as monotherapy in adults without intravascular volume depletion.1 37

Manufacturer states usual dosage is 80–320 mg once daily.1 However, at dosages >80 mg daily, addition of diuretic produces greater BP reduction than increases in valsartan dosage.1

If intolerable adverse effects occur, consider dosage reduction; if adverse effects worsen or fail to resolve, may need to discontinue and switch to another antihypertensive drug class.501

Valsartan/Amlodipine Fixed-combination Therapy
Oral

Fixed-combination preparation may be used for initial treatment of hypertension in patients likely to require combination therapy with multiple antihypertensive agents to control BP.116 Consider potential benefits and risks of initiating therapy with the fixed combination, including whether the patient is likely to tolerate the lowest available dosage of the combined drugs.116

If the patient’s baseline BP is 160/100 mm Hg, the estimated probability of achieving SBP control (SBP <140 mm Hg) is 47, 67, or 80% and of achieving DBP control (DBP <90 mm Hg) is 62, 80, or 85% with valsartan (320 mg daily) alone, amlodipine (10 mg daily) alone, or valsartan combined with amlodipine (at same dosages), respectively.116

In studies using valsartan/amlodipine fixed combination in dosages of valsartan 160–320 mg daily and amlodipine 5–10 mg daily, BP response increased with increasing dosages of the drugs.116

If BP is not adequately controlled by monotherapy with valsartan (or another angiotensin II receptor antagonist) or amlodipine (or another dihydropyridine-derivative calcium-channel blocker), can switch to the fixed-combination preparation containing valsartan 160 mg and amlodipine 5 or 10 mg or, alternatively, valsartan 320 mg and amlodipine 5 or 10 mg.116

If dose-limiting adverse effects have developed during monotherapy with valsartan or amlodipine, can switch to a fixed combination containing a lower dose of that drug to achieve similar BP control; adjust dosage according to patient’s response after 3–4 weeks of therapy.116

If BP is controlled with valsartan and amlodipine (administered separately), can switch to the fixed-combination preparation containing the corresponding individual doses for convenience.116

When used for initial therapy of hypertension in patients likely to require combination therapy with multiple antihypertensive agents, recommended initial dosage is valsartan 160 mg and amlodipine 5 mg daily in those who are not volume depleted.116

Increase to maximum dosage of valsartan 320 mg and amlodipine 10 mg daily, if needed, to control BP.116 May adjust dosage at intervals of 1–2 weeks, since most of the antihypertensive effect of a given dosage is achieved within 2 weeks after a change in dosage.116

Valsartan/Hydrochlorothiazide Fixed-combination Therapy
Oral

Fixed-combination preparation may be used for initial treatment of hypertension in patients likely to require combination therapy with multiple antihypertensive agents to control BP.37 Consider potential benefits and risks of initiating therapy with the fixed combination.37 Not recommended as initial therapy in patients who are volume depleted.37

If the patient’s baseline BP is 160/100 mm Hg, the estimated probability of achieving SBP control (SBP <140 mm Hg) is 41, 50, or 84% and of achieving DBP control (DBP <90 mm Hg) is 60, 57, or 80% with valsartan (320 mg daily) alone, hydrochlorothiazide (25 mg daily) alone, or valsartan combined with hydrochlorothiazide (at same dosages), respectively.37

If BP is not adequately controlled by monotherapy with valsartan (or another angiotensin II receptor antagonist) or hydrochlorothiazide, can switch to fixed-combination tablets containing valsartan 160 mg and hydrochlorothiazide 12.5 mg once daily.37

If dose-limiting adverse effects have developed during monotherapy with valsartan or hydrochlorothiazide, can switch to a fixed combination containing a lower dose of that drug to achieve similar BP control; adjust dosage according to patient’s response after 3–4 weeks of therapy.37

If BP is controlled with valsartan and hydrochlorothiazide (administered separately), can switch to the fixed-combination preparation containing the corresponding individual doses for convenience.37

When used for initial therapy of hypertension in patients likely to require combination therapy with multiple antihypertensive agents, recommended initial dosage is valsartan 160 mg and hydrochlorothiazide 12.5 mg daily in those who are not volume depleted.37 Adjust dosage according to patient’s response after 1–2 weeks of therapy.37

Increase to maximum dosage of valsartan 320 mg and hydrochlorothiazide 25 mg daily, if needed, to control BP.37 Maximum antihypertensive effect of a given dosage is achieved within 2–4 weeks after a change in dosage.37

Heart Failure
Oral

Initially, valsartan 40 mg twice daily.1 Increase dosage to 160 mg twice daily (maximum dosage used in clinical trials) or highest tolerated dosage.1 (See Hypotension under Cautions.)

Heart Failure or Left Ventricular Dysfunction after Acute MI
Oral

Manufacturer states that valsartan therapy may be initiated ≥12 hours post-MI with a dosage of 20 mg twice daily.1 May increase dosage to 40 mg twice daily within 7 days, with subsequent titration to a target maintenance dosage of 160 mg twice daily, as tolerated.1

Consider dosage reduction if symptomatic hypotension or renal dysfunction occurs.1

Special Populations

The following information addresses dosage of valsartan in special populations. Dosages of drugs administered in fixed combination with valsartan also may require adjustment in certain patient populations; the need for such dosage adjustments must be considered in the context of cautions, precautions, and contraindications specific to that population and drug.37 116

Hepatic Impairment

No adjustment of initial valsartan dosage necessary in patients with mild to moderate hepatic impairment.1 116 Cautious dosing recommended in patients with hepatic impairment; titrate dosage slowly.1 37 116

Amount of amlodipine in valsartan/amlodipine fixed combinations exceeds the recommended initial dosage of amlodipine (2.5 mg daily) in patients with hepatic impairment.116

Renal Impairment

No adjustment of initial valsartan dosage necessary in patients with mild to moderate renal impairment.1 37 116 Cautious dosing recommended in adults with severe impairment; titrate dosage slowly.1 116 Use of valsartan in pediatric patients with GFR <30 mL/minute per 1.73 m2 not recommended.1

Valsartan/hydrochlorothiazide fixed combination is not recommended in patients with Clcr ≤30 mL/minute.37 Loop diuretics are preferred to thiazides in these patients.37

Geriatric Patients

No adjustment of initial valsartan dosage is necessary.1 37 116

Amount of amlodipine in valsartan/amlodipine fixed combinations exceeds the recommended initial dosage of amlodipine (2.5 mg daily) in patients ≥75 years of age.116

Volume- and/or Salt-Depleted Patients

Correct volume and/or salt depletion prior to initiation of valsartan therapy or initiate therapy under close medical supervision.1 37 116

Cautions for Valsartan

Contraindications

  • Known hypersensitivity to valsartan or any ingredient in the formulation.37

  • When valsartan is used in fixed combination with hydrochlorothiazide or amlodipine, consider contraindications associated with the concomitant agent.37 116

Warnings/Precautions

Warnings

Fetal/Neonatal Morbidity and Mortality

Possible fetal and neonatal morbidity and mortality when drugs that act directly on the renin-angiotensin system (e.g., angiotensin II receptor antagonists, ACE inhibitors) are used during the second and third trimesters of pregnancy.1 16 17 20 21 22 23 24 25 26 27 28 29 31 32 33 34 35 36 37 116 (See Boxed Warning.) ACE inhibitors also may increase the risk of major congenital malformations when administered during the first trimester of pregnancy.114 115

Discontinue valsartan as soon as possible when pregnancy is detected, unless continued use is considered lifesaving.1 37 114 115 116 Nearly all women can be transferred successfully to alternative therapy for the remainder of their pregnancy.17 25

Hypotension

Possible symptomatic hypotension with valsartan, particularly in volume- and/or salt-depleted patients (e.g., those treated with diuretics).1 37 116 (See Volume- and/or Salt-Depleted Patients under Dosage and Administration.)

Transient hypotension is not a contraindication to additional doses; may reinstate valsartan therapy cautiously after BP is stabilized (e.g., with volume expansion).1 37 116

Initiate valsartan therapy and subsequent dosage adjustments under close medical supervision in patients with heart failure;1 consider reducing diuretic dosage.1

Malignancies

In July 2010, FDA initiated a safety review of angiotensin II receptor antagonists after a published meta-analysis found a modest but statistically significant increase in risk of new cancer occurrence in patients receiving an angiotensin II receptor antagonist compared with control.120 121 123 126 However, subsequent studies, including a larger meta-analysis conducted by FDA, have not shown such risk.126 127 128 129 Based on currently available data, FDA has concluded that angiotensin II receptor antagonists do not increase the risk of cancer.126

Sensitivity Reactions

Anaphylactoid reactions and/or angioedema possible with angiotensin II receptor antagonists;1 37 116 118 extreme caution in patients with a history of angioedema associated with or unrelated to ACE inhibitor or angiotensin II receptor antagonist therapy.117 119

General Precautions

Use of Fixed Combinations

When valsartan is used in fixed combination with amlodipine or hydrochlorothiazide, consider the cautions, precautions, contraindications, and interactions associated with the concomitant agent.37 116 Consider cautionary information applicable to specific populations (e.g., pregnant or nursing women, individuals with hepatic or renal impairment, geriatric patients) for each drug in the fixed combination.37 116

Renal Effects

Possible oliguria, progressive azotemia and, rarely, acute renal failure and/or death in patients with severe heart failure.1 37 116

Increases in BUN and Scr possible in patients with unilateral or bilateral renal artery stenosis.1 37 116

Hyperkalemia

Hyperkalemia may occur, especially in patients with heart failure and preexisting renal impairment.1 116

Specific Populations

Pregnancy

Category D.1 37 116 (See Boxed Warning.)

Lactation

Valsartan is distributed into milk in rats; not known whether valsartan is distributed into human milk.1 37 116 Discontinue nursing or the drug.1 37 116

Pediatric Use

Safety and efficacy of valsartan in pediatric patients 6–16 years of age with hypertension established in a controlled clinical trial.1 Some evidence of efficacy in a controlled clinical trial in pediatric patients 1–5 years of age; however, 2 deaths and 3 cases of transaminase elevations were observed in an open-label extension study in this age group.1 Although causal relationship to valsartan has not been established, use is not recommended in pediatric patients <6 years of age.1

Safety and efficacy of valsartan not established in children with GFR <30 mL/minute per 1.73 m2.1

Safety and efficacy of valsartan in fixed combination with amlodipine or hydrochlorothiazide not established in children.37 116

Geriatric Use

No substantial differences in safety or efficacy relative to younger adults, but increased sensitivity to valsartan alone or in fixed combination with amlodipine or hydrochlorothiazide cannot be ruled out.1 37 116

Hepatic Impairment

Systemic exposure to valsartan may be increased (see Absorption: Special Populations, under Pharmacokinetics).1 37 116 Use with caution.1 37 116

Renal Impairment

Valsartan not studied in patients with Clcr <10 mL/minute; use with caution in adults with severe renal impairment.1 18 37 116 Valsartan not studied in children with GFR <30 mL/minute per 1.73 m2; use not recommended.1

Deterioration of renal function may occur.1 37 116 (See Renal Effects under Cautions.)

Use of valsartan in fixed combination with hydrochlorothiazide is not recommended in patients with Clcr ≤30 mL/minute.37

Black Patients

BP reduction with angiotensin II receptor antagonists may be smaller in black patients compared with nonblack patients..1 37 (See Hypertension under Uses.)

Common Adverse Effects

Viral infection,1 fatigue,1 abdominal pain;1 also, dizziness,1 hypotension,1 postural dizziness or hypotension,1 hyperkalemia,1 arthralgia,1 diarrhea,1 and back pain in patients with heart failure.1

Interactions for Valsartan

The following information addresses potential interactions with valsartan. When valsartan is used in fixed combination with hydrochlorothiazide or amlodipine, consider interactions associated with the concomitant agent.37 116

Valsartan is metabolized in the liver, but the precise enzymes responsible are unknown but not believed to involve CYP enzymes.1 37 116 Not known whether valsartan induces or inhibits CYP enzymes.1 37 116

In vitro data suggest that valsartan is a substrate of organic anion transporter protein (OATP) 1B1 (hepatic uptake transporter) and multidrug resistance protein MRP2 (hepatic efflux transporter).1

Drugs That Inhibit Hepatic Transport Systems

Inhibitors of OATP 1B1 or MRP2: Possible increased systemic exposure to valsartan.1

Specific Drugs

Drug

Interaction

Comments

Amlodipine

Pharmacokinetic interaction unlikely1 37 116

Atenolol

Pharmacokinetic interaction unlikely1 37 116

Additive antihypertensive effect; heart rate unaffected1 37 116

Cimetidine

Pharmacokinetic interaction unlikely1 37 116

Cyclosporine

Possible increased systemic exposure to valsartan1

Digoxin

Pharmacokinetic interactions unlikely1 37 116

Diuretic, potassium-sparing (e.g., amiloride, spironolactone, triamterene)

Possible additive hyperkalemic effects;1 37 116 possible increase in Scr in patients with heart failure1 116

Furosemide

Pharmacokinetic interactions unlikely1 37 116

Glyburide

Pharmacokinetic interactions unlikely1 37 116

Hydrochlorothiazide

Pharmacokinetic interactions unlikely1 37 116

Additive hypotensive effects1 37

Indomethacin

Pharmacokinetic interactions unlikely1 37 116

NSAIAs, including selective cyclooxygenase-2 (COX-2) inhibitors

Possible deterioration of renal function in geriatric, volume-depleted, or renally impaired patients1

Possible reduced antihypertensive effects1

Monitor renal function periodically1

Potassium supplements and potassium-containing salt substitutes

Possible additive hyperkalemic effect;1 37 116 possible increase in Scr in patients with heart failure1 116

Rifampin

Possible increased systemic exposure to valsartan1

Ritonavir

Possible increased systemic exposure to valsartan1

Warfarin

Pharmacokinetic interactions unlikely; INR unaffected1 37 116

Valsartan Pharmacokinetics

Absorption

Bioavailability

Absolute bioavailability of valsartan tablets is about 25% (range: 10–35%).1 37 116 Bioavailability of extemporaneously prepared suspension (see Reconstitution under Dosage and Administration) is 1.6 times greater than that of the tablets.1

Peak plasma concentration of valsartan reached about 2–4 hours following oral administration.1 37 116

Onset

Antihypertensive effect of valsartan evident within 2 weeks, with maximum BP reduction after 4 weeks.1 37

Food

Food may decrease rate and extent (e.g., AUC decreased by about 40%) of absorption of valsartan.1 9 37 116

Special Populations

In patients with mild to moderate chronic liver disease, systemic exposure to valsartan is doubled.1 37 116

Distribution

Extent

Valsartan crosses the placenta and is distributed in the fetus in animals.1 37

Valsartan is distributed into milk in rats; not known whether valsartan is distributed into human milk.1 37 116

Plasma Protein Binding

Valsartan: 95% (mainly albumin).1 37 116

Elimination

Metabolism

Valsartan is metabolized in the liver, but the precise enzymes responsible are unknown.1 37 116 CYP enzymes do not appear to play a role.1 37 116

Elimination Route

Valsartan is eliminated mainly as unchanged drug in feces (83%) and urine (13%).1 37 116

Half-life

Biexponential; average half-life of valsartan is approximately 6 hours following IV administration.1 37 116

Valsartan clearance is similar in adults and children.1

Special Populations

Valsartan is not removed by hemodialysis.1 37 116

Stability

Storage

Oral

Extemporaneous Suspension

Valsartan 4 mg/mL in Ora-Sweet SE and Ora-Plus (see Reconstitution under Dosage and Administration), stored in amber glass bottle with child-resistant screw-cap closure: Up to 30 days at <30ºC or up to 75 days at 2–8ºC.1

Tablets

Valsartan, valsartan/amlodipine or valsartan/hydrochlorothiazide fixed combination: Tight container at 25°C (may be exposed to 15–30°C).1 37 116 Protect from moisture.1 37 116

Actions

  • Valsartan blocks the physiologic actions of angiotensin II, including vasoconstrictor and aldosterone-secreting effects.1 6 10 37 116

  • Valsartan does not interfere with response to bradykinins and substance P.1 4 6 10 37 116

  • Valsartan does not share the ACE inhibitor common adverse effect of dry cough.1 4 6 10

Advice to Patients

  • When valsartan is used in fixed combination with hydrochlorothiazide or amlodipine, importance of advising patients of important precautionary information about the concomitant agent.37 116

  • Risks of use during pregnancy.1 37 114 115 116

  • Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed.1 37 116

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs (including salt substitutes containing potassium).1 37 116

  • Importance of contacting clinician if dizziness or faintness develops or if unexplained weight gain or swelling of the feet, ankles, or hands occurs.1 37 116

  • Importance of informing patients of other important precautionary information.1 37 116 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Valsartan

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

40 mg

Diovan (scored)

Novartis

80 mg

Diovan

Novartis

160 mg

Diovan

Novartis

320 mg

Diovan

Novartis

Valsartan Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

80 mg with Hydrochlorothiazide 12.5 mg

Diovan HCT

Novartis

160 mg with Hydrochlorothiazide 12.5 mg

Diovan HCT

Novartis

160 mg with Hydrochlorothiazide 25 mg

Diovan HCT

Novartis

320 mg with Hydrochlorothiazide 12.5 mg

Diovan HCT

Novartis

320 mg with Hydrochlorothiazide 25 mg

Diovan HCT

Novartis

Tablets, film-coated

160 mg with Amlodipine Besylate 5 mg (of amlodipine)

Exforge

Novartis

160 mg with Amlodipine Besylate 10 mg (of amlodipine)

Exforge

Novartis

320 mg with Amlodipine Besylate 5 mg (of amlodipine)

Exforge

Novartis

320 mg with Amlodipine Besylate 10 mg (of amlodipine)

Exforge

Novartis

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 12/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Diovan 160MG Tablets (NOVARTIS): 30/$111.99 or 90/$311.99

Diovan 320MG Tablets (NOVARTIS): 30/$136.99 or 90/$388.97

Diovan 40MG Tablets (NOVARTIS): 30/$89.99 or 90/$249.98

Diovan 80MG Tablets (NOVARTIS): 30/$100.99 or 90/$285.96

Diovan HCT 160-12.5MG Tablets (NOVARTIS): 30/$117.99 or 90/$331.97

Diovan HCT 160-25MG Tablets (NOVARTIS): 30/$130.99 or 90/$371.97

Diovan HCT 320-12.5MG Tablets (NOVARTIS): 30/$142.99 or 90/$409.99

Diovan HCT 320-25MG Tablets (NOVARTIS): 30/$168.99 or 90/$485.97

Diovan HCT 80-12.5MG Tablets (NOVARTIS): 30/$110.99 or 90/$310.97

Exforge 10-160MG Tablets (NOVARTIS): 30/$135.99 or 90/$375.99

Exforge 10-320MG Tablets (NOVARTIS): 30/$169.99 or 90/$485.97

Exforge 5-160MG Tablets (NOVARTIS): 30/$119.99 or 90/$341.97

Exforge 5-320MG Tablets (NOVARTIS): 30/$151.00 or 90/$433.98

Exforge HCT 10-160-12.5MG Tablets (NOVARTIS): 30/$128.99 or 90/$372.95

Exforge HCT 5-160-12.5MG Tablets (NOVARTIS): 30/$117.99 or 90/$341.97

Exforge HCT 5-160-25MG Tablets (NOVARTIS): 30/$119.99 or 90/$339.99

Valturna 150-160MG Tablets (NOVARTIS): 30/$95.99 or 90/$270.97

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions November 12, 2014. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

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