Torval H 80/12.5/Torval H 160/12.5 Dosage/Direction for Use

The recommended starting dose of Valsartan is 80 mg or 160 mg once daily when used as monotherapy in patients who are not volume depleted. Patients requiring greater reductions may be started at the higher dose. Valsartan may be used over a dose range of 80 mg to 320 mg daily, administered once-a day. Hydrochlorothiazide is effective in doses of 12.5 to 50 mg once daily, and can be given at doses of 12.5 mg to 25 mg as valsartan and hydrochlorothiazide. To minimize dose-independent side effects, it is usually appropriate to begin combination therapy only after a patient has failed to achieve the desired effect with monotherapy.
Dose titration: A patient whose blood pressure is not adequately controlled with valsartan monotherapy may add hydrochlorothiazide by switching to Valsartan and Hydrochlorothiazide (Valsartan 80 mg/hydrochlorothiazide 12.5 mg or valsartan 160 mg/hydrochlorothiazide 12.5 mg) once daily. If blood pressure remains uncontrolled after about 3-4 weeks of therapy, either valsartan or both components may be increased depending on clinical response. A patient whose blood pressure is inadequately controlled by 25 mg once daily of hydrochlorothiazide, or is controlled but who experiences hypokalemia with this regimen, may be switched to valsartan and hydrochlorothiazide (valsartan 80 mg/hydrochlorothiazide 12.5 mg or valsartan 160 mg/hydrochlorothiazide 12.5 mg) once daily, reducing the dose of hydrochlorothiazide without reducing the overall expected antihypertensive response. The clinical response to valsartan and hydrochlorothiazide should be subsequently evaluated and if blood pressure remains uncontrolled after 3-4 weeks of therapy, the dose may be titrated up to valsartan 160 mg/hydrochlorothiazide 25 mg. The maximal antihypertensive effect is attained about 4 weeks after initiation of therapy.
Patients with Renal Impairment: The usual regimens of therapy with valsartan and hydrochlorothiazide may be followed as long as the patient's creatinine clearance is >30 mL/min. In patients with more severe renal impairment, loop diuretics are preferred to thiazides, so valsartan and hydrochlorothiazide is not recommended.
Patients with Hepatic Impairment: Care should be exercised with dosing of valsartan and hydrochlorothiazide in patients with hepatic impairment. No initial dosage adjustment is required for elderly patients. Valsartan and hydrochlorothiazide may be administered with other antihypertensive agents. Valsartan and hydrochlorothiazide may be administered with or without food.