hydrochlorothiazide + valsartan: clinical use

Prescribing considerations

• Correct significant sodium or volume depletion before initiation.
• Use caution with renal or hepatic impairment, valve stenosis, hypertrophic obstructive cardiomyopathy, previous angioedema, diabetes, gout, lupus or photosensitivity.
• Review hydrochlorothiazide use after previous non-melanoma skin cancer and counsel about UV protection and skin surveillance.
• Not recommended for children because safety and efficacy data are lacking.

Contraindications and cautions

• Hypersensitivity to either active ingredient, sulfonamide-derived medicines or an excipient
• Second or third trimester of pregnancy
• Severe renal impairment or anuria
• Severe hepatic impairment, biliary cirrhosis or cholestasis
• Refractory hypokalaemia or hyponatraemia, hypercalcaemia, or symptomatic hyperuricaemia
• Aliskiren co-administration in diabetes or qualifying renal impairment

Monitoring

• Blood pressure and symptoms of hypotension or volume depletion
• Renal function and serum potassium, sodium, magnesium and calcium
• Uric acid and glucose where clinically relevant
• New or changing skin lesions during long-term hydrochlorothiazide exposure
• Visual symptoms, angioedema and unexplained acute respiratory deterioration

Clinical pharmacology

Valsartan selectively antagonises angiotensin II at AT1 receptors. Hydrochlorothiazide inhibits sodium–chloride transport in the distal convoluted tubule, promoting natriuresis and reducing plasma volume; valsartan partly moderates thiazide-related potassium loss.

Formulation and product differences

• The selected product is a brown-orange, ovaloid film-coated tablet marked “I” and “63”.
• It contains lactose monohydrate and is essentially sodium-free.
• It may be supplied in blister or bottle packaging; bottles contain a desiccant.

Tablet

Route: Oral

Strengths: 80 mg + 12.5 mg, 160 mg + 12.5 mg, 160 mg + 25 mg