CHF and arrhythmias:
Indications for: DIOVAN
Heart failure (NYHA Class II–IV). To reduce cardiovascular mortality in stable post-MI patients with left ventricular failure or dysfunction.
Adult Dosage:
Heart failure: initially 40mg twice daily, increase to 80mg twice daily, then to 160mg twice daily as tolerated. Post-MI: may start 12hrs post-MI; initially 20mg twice daily, increase within 1 wk to 40mg twice daily; target maintenance: 160mg twice daily as tolerated. Low BP or renal dysfunction: reduce dose.
Children Dosage:
Not recommended.
DIOVAN Contraindications:
Concomitant aliskiren in patients with diabetes.
Boxed Warning:
Fetal toxicity.
DIOVAN Warnings/Precautions:
Tabs and oral suspension are not substitutable on a mg-per-mg basis. Fetal toxicity may develop; discontinue if pregnancy is detected. CHF. Post-MI. Correct salt/volume depletion prior to initiation. Monitor renal function in renal artery stenosis, chronic kidney disease, severe CHF, or volume depletion. Monitor for hyperkalemia in renal insufficiency. Severe hepatic or renal impairment (GFR <30mL/min/1.73m2), or children undergoing dialysis: not established. Neonates. Pregnancy: avoid. Nursing mothers: not recommended.
DIOVAN Classification:
Angiotensin II receptor blocker (ARB).
DIOVAN Interactions:
See Contraindications. Concomitant renin-angiotensin system (RAS) inhibitors, K+ supplements, K+ sparing diuretics, K+-containing salt substitutes or other drugs (eg, heparin) may cause hyperkalemia and, in heart failure patients to increases in serum creatinine. May increase lithium levels; monitor. 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). May be potentiated by inhibitors of OATP1B1 (eg, rifampin, cyclosporine) or MRP2 (eg, ritonavir). Dual inhibition of the RAS 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 (GFR <60mL/min): not recommended.
Adverse Reactions:
Dizziness, hypotension, diarrhea, arthralgia, back pain, fatigue, hyperkalemia, cough, increased BUN, increased blood creatinine, neutropenia, rhabdomyolysis (rare).
Generic Drug Availability:
YES
How Supplied:
Tabs 40mg—30; 80mg, 160mg, 320mg—90
Hypertension:
Indications for: DIOVAN
Hypertension.
Adult Dosage:
Monotherapy and not volume-depleted: initially 80mg or 160mg once daily; max 320mg once daily. Or, add a diuretic (more effective than increasing dose above 80mg).
Children Dosage:
<1yr: not recommended. 1–16yrs: Initially 1mg/kg once daily (up to 40mg total), may consider an initial dose of 2mg/kg if greater BP reduction is needed; max 4g/kg (up to 160mg) once daily. If aged 1–5yrs, >5yrs who are unable to swallow tabs, or calculated dose (mg/kg) does not correspond to available tablet strengths, use suspension (see full labeling for susp preparation).
DIOVAN Contraindications:
Concomitant aliskiren in patients with diabetes.
Boxed Warning:
Fetal toxicity.
DIOVAN Warnings/Precautions:
Tabs and oral suspension are not substitutable on a mg-per-mg basis. Fetal toxicity may develop; discontinue if pregnancy is detected. CHF. Post-MI. Correct salt/volume depletion prior to initiation. Monitor renal function in renal artery stenosis, chronic kidney disease, severe CHF, or volume depletion. Monitor for hyperkalemia in renal insufficiency. Severe hepatic or renal impairment (GFR <30mL/min/1.73m2), or children undergoing dialysis: not established. Neonates. Pregnancy: avoid. Nursing mothers: not recommended.
DIOVAN Classification:
Angiotensin II receptor blocker (ARB).
DIOVAN Interactions:
See Contraindications. Concomitant renin-angiotensin system (RAS) inhibitors, K+ supplements, K+ sparing diuretics, K+-containing salt substitutes or other drugs (eg, heparin) may cause hyperkalemia and, in heart failure patients to increases in serum creatinine. May increase lithium levels; monitor. 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). May be potentiated by inhibitors of OATP1B1 (eg, rifampin, cyclosporine) or MRP2 (eg, ritonavir). Dual inhibition of the RAS 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 (GFR <60mL/min): not recommended.
Adverse Reactions:
Headache, dizziness, viral infection, fatigue, abdominal pain, neutropenia, rhabdomyolysis (rare).
Generic Drug Availability:
YES
How Supplied:
Tabs 40mg—30; 80mg, 160mg, 320mg—90
