Pharmacological properties of the drug Valsacor
The active hormone of the renin-angiotensin-aldosterone system is angiotensin II, which is formed from angiotensin I with the participation of ACE. Angiotensin II binds to specific receptors that are located on the cell membranes of various tissues. It has a whole range of physiological effects, exhibiting both direct and indirect effects on the regulation of blood pressure. As a powerful vasoconstrictor, angiotensin II has a direct pressor effect. In addition, it promotes sodium retention and aldosterone secretion. Valsartan is an oral, potent and specific angiotensin II receptor antagonist. Selectively acts on receptors of the AT1 subtype, which are responsible for the action of angiotensin II. When the concentration of angiotensin II in the blood plasma increases after blockade of AT1 receptors by valsartan, stimulation of unblocked AT2 receptors occurs, which regulate the action of AT1 receptors. Valsartan does not exhibit any agonistic activity towards AT1 receptors and has a significantly greater affinity (approximately 20,000 times) for AT1 receptors than for AT2 receptors. Valsartan does not inhibit the activity of ACE, also known as kininase II, an enzyme that converts angiotensin I into angiotensin II and catalyzes the breakdown of bradykinin. Angiotensin II antagonists do not cause cough because they do not affect the activity of ACE and do not increase the production of bradykinin and substance P. In clinical studies in which valsartan was compared with other ACE inhibitors, the incidence of dry cough in patients taking valsartan was significantly lower (P ≤0.05) than in patients using an ACE inhibitor (2.6% compared with 7.9%). In a clinical trial, dry cough was reported in 19.5% of patients taking valsartan, 19.0% of patients taking a thiazide diuretic, compared with 68.5% of patients taking an ACE inhibitor (P≤0.05). Valsartan does not bind to or block other hormonal receptors or ion channels important for the regulation of the cardiovascular system. Treatment of patients with hypertension (arterial hypertension) with valsartan helped reduce blood pressure without affecting heart rate. In most patients, the hypotensive effect develops within 2 hours after a single oral dose, and the maximum effect on blood pressure is observed after 4–6 hours and lasts 24 hours. With repeated administration of the drug at any dose, the maximum reduction in blood pressure is achieved after 2–4 weeks and persists throughout the entire treatment period. With the combined use of hydrochlorothiazide, a significant additional reduction in blood pressure occurs. Discontinuation of valsartan does not cause a sudden increase in blood pressure and other undesirable clinical events in patients. In a long-term study of the use of valsartan in patients with heart failure, it was noted that in patients taking valsartan, there was a decrease in plasma norepinephrine and brain natriuretic peptide levels compared to the initial level. Valsartan produced significant improvements in pulmonary capillary wedge pressure, systemic vascular resistance, cardiac output, and systolic blood pressure. Patients using valsartan experience a significant increase in ejection fraction and a decrease in the internal diameter of the left ventricle compared to the initial state, and a significant decrease in the severity of symptoms of heart failure, including shortness of breath, fatigue, swelling and breath sounds. Valsartan is rapidly absorbed after oral administration, but the amount absorbed varies significantly. The average absolute bioavailability of valsartan is 23%. Valsartan is characterized by multi-exponential elimination kinetics (half-life in the α phase ≤1 hour and half-life in the β phase ≈9 hours). The pharmacokinetics of valsartan in the studied dose range is linear. With repeated administration of the drug, the pharmacokinetic parameters do not change; When the drug is administered once a day, only a slight accumulation of valsartan is observed. Valsartan binds well to serum proteins (94–97%), mostly to albumin. The volume of distribution at steady state is low (≈17 l). Plasma clearance occurs relatively slowly (≈2 L/h) compared to hepatic blood flow (≈30 L/h). The drug is excreted mainly unchanged: 70% of the absorbed amount is in feces, 30% in urine. When valsartan is taken with food, AUC decreases by 48%; however, after 8 hours, the concentration of valsartan in the blood plasma is the same both when taken on an empty stomach and when taken with food. This indicates the possibility of using valsartan regardless of food intake.
Valsacor
When using the drug Valsacor in patients with hypertension, regular monitoring of laboratory parameters is not required.
Hyponatremia and/or dehydration.
In patients with severe hyponatremia and/or dehydration, for example due to taking large doses of diuretics, in rare cases, arterial hypotension with clinical manifestations may develop at the beginning of therapy with Valsacor. Before starting treatment, it is recommended to restore the sodium content and/or replenish the volume of blood volume, in particular by reducing the doses of diuretics.
If arterial hypotension with clinical manifestations develops: the patient must be placed in a horizontal position and, if necessary, injected intravenously with a 09% sodium chloride solution. Therapy with Valsacor can be continued only after stabilization of hemodynamic parameters.
Hyperkalemia.
The simultaneous use of potassium-sparing diuretics (spironolactone eplerenone triamterene amiloride), potassium preparations, potassium-containing nutritional supplements or other drugs that can increase the level of potassium in the blood serum (for example, heparin) is not recommended. It is necessary to monitor the potassium content in the blood plasma.
Renal artery stenosis.
Short-term use of valsartan in patients with renovascular hypertension developed secondary to unilateral stenosis of the artery of a solitary kidney was not accompanied by significant changes in renal hemodynamic parameters, creatinine or urea nitrogen concentrations in the blood serum. Since other drugs acting on the RAAS can increase the concentrations of urea and creatinine in the blood serum in patients with bilateral renal artery stenosis or stenosis of the artery of a solitary kidney, it is recommended as a precaution to constantly monitor these indicators.
Condition after kidney transplantation.
The safety of Valsacor in patients who have recently undergone kidney transplantation has not been established.
Primary hyperaldosteronism.
Patients with primary hyperaldosteronism are resistant to antihypertensive drugs that affect the RAAS; therefore, the use of Valsacor is not recommended for such patients.
Stenosis of the aortic and/or mitral valves HOCM.
Valsacor should be used with caution in patients with hemodynamically significant stenosis of the aortic and/or mitral valves or with HOCM.
Renal dysfunction.
In patients with impaired renal function, no dose changes are required. Since there is no data on the use of the drug in severe renal failure (creatinine clearance less than 10 ml/min or 0167 ml/s) and in patients on hemodialysis in such cases the drug is recommended to be used with caution.
The simultaneous use of ARB II including valsartan or ACE inhibitors with aliskiren is contraindicated in patients with impaired renal function (creatinine clearance less than 60 ml/min).
Liver dysfunction.
For patients with mild or moderate liver dysfunction of non-biliary origin without cholestasis, the drug Valsacor at a dosage of 320 mg is contraindicated since the maximum daily dose should not exceed 80 mg.
History of angioedema.
Among patients with angioedema (swelling of the larynx and vocal cords causing obstruction of the airways and/or swelling of the face, lips, pharynx and/or tongue) during treatment with Valsacor, cases of a history of angioedema development were observed, including in response to ACE inhibitors. If angioedema develops, the drug should be discontinued immediately and the possibility of repeated use should be excluded.
Arterial hypertension.
For hypertension, the drug Valsacor can be used in monotherapy or simultaneously with other antihypertensive drugs, in particular diuretics.
CHF/increasing survival of patients with acute myocardial infarction.
It is possible to use the drug Valsacor in combination with other drugs used for acute myocardial infarction (thrombolytics, acetylsalicylic acid as an antiplatelet agent, beta-blockers and HMG-CoA reductase inhibitors (statins)). The simultaneous use of Valsacor and ACE inhibitors in this category of patients is not recommended because this combination therapy does not lead to an additional clinical effect and is accompanied by an increased risk of adverse events compared to therapy with the two drugs separately.
In patients with CHF, triple combination therapy: Valsacor with an ACE inhibitor and a beta-blocker is not recommended because it does not lead to additional clinical effect and is accompanied by an increased risk of adverse events.
The use of the drug Valsacor in patients with CHF or acute myocardial infarction often leads to a slight decrease in blood pressure, usually without discontinuation of the drug when dosing instructions are followed.
In patients whose renal function may depend on the activity of the RAAS (for example, in patients with CHF II-IV FC according to the NYNA classification), therapy with ACE inhibitors and ARA II is accompanied by oliguria and/or an increase in azotemia and, in rare cases, acute renal failure and/or death . Since valsartan is an ARA II, the possibility of deterioration of renal function with its use cannot be excluded.
Initiation of therapy in patients with CHF or acute myocardial infarction should be done with caution. Renal function should always be assessed when assessing patients.
Special information on excipients.
The drug Valsacor contains lactose; therefore, the drug is contraindicated in patients with lactase deficiency, lactose intolerance, and glucose-galactose malabsorption syndrome.
Care must be taken when driving vehicles and engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions, as dizziness or weakness may develop due to arterial hypotension.
Use of the drug Valsacor
AH (arterial hypertension) The recommended dose of Valsacor is 80 mg 1 time per day, regardless of the patient’s age, gender or race. The hypotensive effect is achieved after 2 weeks, and the maximum antihypertensive effect is achieved after 4 weeks of treatment. For patients who do not achieve an adequate reduction in blood pressure, the daily dose can be increased to 160 mg or supplemented with diuretic therapy. There is no need to change the dose in patients with impaired renal or hepatic function of non-biliary origin in the absence of cholestasis. Valsacor can also be taken in combination with other antihypertensive drugs. Heart failure The recommended initial dose is 40 mg 2 times a day. This dose is gradually increased to 80 mg twice daily and then to 160 mg twice daily, the highest dose the patient can tolerate. The maximum daily dose of valsartan is 320 mg. For patients who are simultaneously treated with a diuretic, it is recommended to reduce the dose of Valsacor. Post-myocardial infarction Treatment with the drug can begin 12 hours after myocardial infarction. The initial dose of Valsacor is 20 mg 2 times a day. At the beginning of treatment, it is recommended to use Valsacor 40 mg tablets with a notch on one side. After a few weeks, the dose should be gradually increased to 40, 80 and 160 mg 2 times a day, depending on the patient’s tolerance to treatment. If symptomatic hypotension or renal failure occurs, the dose should be reduced.
Valsacor, 30 pcs., 80 mg, film-coated tablets
Hyperkalemia.
Caution should be exercised when using potassium-sparing diuretics (spironolactone, eplerenone, triamterene, amiloride), potassium supplements, potassium-containing salt substitutes or other drugs that can increase plasma potassium levels (for example, heparin). It is necessary to regularly monitor the potassium content in the blood plasma.
Renal dysfunction.
In patients with impaired renal function, no dose changes are required. Because There are no data on the use of the drug in severe renal failure (creatinine Cl less than 10 ml/min or 0.167 ml/s) and in patients on hemodialysis; in such cases, the drug is recommended to be used with caution.
The simultaneous use of valsartan with aliskiren in patients with moderate and severe renal impairment (creatinine clearance less than 60 ml/min) is contraindicated.
Liver dysfunction.
In patients with mild to moderate liver dysfunction without cholestasis, Valsacor® should be used with caution.
Patients with hyponatremia and/or dehydration.
In patients with severe hyponatremia and/or dehydration, for example due to taking large doses of diuretics, in rare cases, arterial hypotension with clinical manifestations may develop at the beginning of therapy with Valsacor®. Before starting treatment, it is recommended to restore sodium and/or bcc levels, in particular by reducing the doses of diuretics.
Renal artery stenosis.
The use of valsartan in a short course in patients with renovascular hypertension, which developed secondary to stenosis of the artery of a single kidney, does not cause significant changes in renal hemodynamics, creatinine concentration or urea nitrogen in the blood serum. However, given that other drugs that affect the RAAS may cause an increase in serum urea and creatinine concentrations in patients with bilateral renal artery stenosis or arterial stenosis of a solitary kidney, it is necessary to regularly monitor the concentrations of creatinine and residual urea nitrogen in the blood serum.
Condition after kidney transplantation.
The safety of using Valsacor® in patients who have recently undergone kidney transplantation has not been established.
Primary hyperaldosteronism.
Patients with primary hyperaldosteronism are resistant to antihypertensive drugs that affect the RAAS, therefore the use of Valsacor® is not recommended for such patients.
Stenosis of the aortic and/or mitral valves, HOCM.
The drug Valsacor® should be used with caution in patients with hemodynamically significant stenosis of the aortic and/or mitral valves or with HOCM.
The period after an MI.
Concomitant use with ACE inhibitors is not recommended, because has no additional clinical benefits over monotherapy and increases the risk of adverse events.
The use of valsartan in patients after a myocardial infarction often leads to a slight decrease in blood pressure, but discontinuation of therapy due to arterial hypotension is usually not required if drug dosage recommendations are followed.
Treatment with Valsacor® should be initiated cautiously. Assessment of the condition of patients after acute myocardial infarction should include monitoring of renal function.
Possible simultaneous use in acute MI with other drugs: thrombolytics, acetylsalicylic acid, beta-blockers and HMG-CoA reductase inhibitors (statins).
CHF.
In patients with CHF, the simultaneous use of three classes of drugs is not recommended: ACE inhibitors, beta-blockers and valsartan, because this therapy did not provide additional clinical effect, and the risk of adverse events increased. Use in patients with CHF is usually accompanied by a decrease in blood pressure, however, if recommendations for dose selection are followed, treatment rarely requires discontinuation due to arterial hypotension. Treatment with Valsacor® in patients with CHF should be initiated with caution. Due to the suppression of RAAS activity in some patients (for example, in patients with CHF III–IV functional class according to the NYNA classification, whose kidney function depends on the state of the RAAS) during therapy with ACE inhibitors, a change in renal function is possible: the development of oliguria and/or progressive azotemia, and in in rare cases - acute renal failure and/or death. The drug Valsacor® blocks angiotensin II receptors, so patients with CHF require regular monitoring of renal function.
History of angioedema.
Among patients with angioedema during therapy with Valsacor®, there were cases of a history of angioedema, incl. and ACE inhibitors. If angioedema develops, the drug should be discontinued immediately and the possibility of repeated use should be excluded.
Special information on excipients
The drug Valsacor® contains lactose, so it should not be used for the following conditions: lactose intolerance, lactase deficiency, glucose-galactose malabsorption syndrome.
Impact on the ability to perform potentially hazardous activities that require special attention and quick reactions (for example, driving, working with moving mechanisms).
Due to the possibility of dizziness or weakness while using the drug Valsacor®, care must be taken when driving vehicles and engaging in potentially hazardous activities.
Side effects of the drug Valsacor
During treatment with the drug, viral infections, upper respiratory tract infections, rhinitis, sinusitis, and pharyngitis often occurred (≥1%). Nervous system and mental disorders; headache, dizziness; cough; nausea, diarrhea, abdominal pain; back pain and arthralgia; hyperkalemia; fatigue. Rarely (≤1%) rash, itching, insomnia, and swelling were noted; isolated cases of hypersensitivity reactions; very rarely - renal function disorders. The frequency of side effects does not depend on the dose and period of treatment, as well as the gender, race and age of the patient.
Precautions and contraindications
Valsacor requires careful use and constant monitoring of well-being in cases of impaired renal and liver function during treatment after a heart attack. The drug enhances the toxic effect of medications containing acetylsalicylic acid. It is not advisable to take Valsacor simultaneously with cardiac glycosides, anti-gout medications, or potassium-sparing agents.
When combined with barbiturates, adrenergic blockers, vasodilators, the diuretic and hypotensive effect of Valsacor is enhanced. It is important to remember this when choosing dosages.
The medicine affects psychomotor reactions, so during the treatment period caution is required when creating vehicles and operating special equipment.
The drug is incompatible with alcohol and can provoke a sharp drop in blood pressure, hypoxia and vascular collapse.
It is necessary to refuse therapy with Valsacor:
- with renal artery stenosis, not on hemodialysis, with severe renal failure;
- with cirrhosis, severe hepatosis;
- acute dehydration;
- during pregnancy and lactation;
- in case of individual intolerance to the components.
Caution is required in various forms of cardiomyopathy, stenosis of the mitral valve or aorta.
Special instructions for the use of the drug Valsacor
Caution should be exercised when starting treatment in patients with heart failure after myocardial infarction. They often initially experience a slight decrease in blood pressure, however, if dosing instructions are properly followed, such symptomatic hypotension for the most part does not cause discontinuation of treatment. During treatment with Valsacor, renal function should be regularly checked in patients with heart failure and special caution should be exercised with the combined use of ACE inhibitors, beta-adrenergic blockers and angiotensin II receptor antagonists (AT1 subtype). In debilitated patients and/or with significantly reduced sodium levels (for example, those taking high doses of diuretics), symptomatic hypotension may rarely occur when starting treatment with Valsacor. Before starting therapy, it is necessary to restore the amount of water and sodium in the body (for example, by reducing the dose of the diuretic). If arterial hypotension occurs, the patient should be placed in a horizontal position and, if necessary, given an intravenous infusion of 0.9% sodium chloride solution. After stabilization of blood pressure, treatment with Valsacor can be continued. During therapy, it is recommended to carefully evaluate patients with unilateral or bilateral renal artery stenosis, since drugs that affect the activity of the renin-angiotensin-aldosterone system can cause an increase in serum urea and creatinine levels. The drug should be used with caution in patients with impaired renal function and obstructive diseases of the biliary tract. In this case, the dose should not be reduced. Since Valsacor contains lactose, the drug is not recommended for use in patients with galactosemia, lactase deficiency or impaired glucose/galactose absorption. In patients with hypersensitivity, changes in the functional activity of the kidneys may occur, which are caused by inhibition of the activity of the renin-angiotensin system. Treatment with ACE inhibitors and angiotensin II receptor antagonists (AT1 subtype) should not be carried out in patients whose renal function depends on the activity of the renin-angiotensin-aldosterone system. This can cause oliguria, progressive azotemia, and sometimes acute renal failure or death. Children. The safety and effectiveness of the drug in treating children has not been established. Period of pregnancy or breastfeeding. Given the mechanism of action of angiotensin II receptor antagonists, a risk to the fetus cannot be excluded. It has been shown that the use of ACE inhibitors in the second and third trimester of pregnancy can cause damage and death of the fetus. Like other drugs that act directly on the renin-angiotensin-aldosterone system, Valsacor is not recommended for use during pregnancy. It is not known whether valsartan passes into breast milk, so Valsacor is not recommended for use during breastfeeding. The ability to influence reaction speed when driving vehicles or working with other mechanisms. As with the use of other antihypertensive drugs, during treatment with Valsacor it is recommended to exercise caution when driving vehicles and operating machinery.
Valsacor®
When using Valsacor® in patients with hypertension, regular monitoring of laboratory parameters is not required.
Double blockade of the RAAS
In some patients, double blockade of the RAAS was accompanied by the development of severe arterial hypotension, syncope, stroke, hyperkalemia and renal dysfunction (including acute renal failure).
The simultaneous use of ARB II, including valsartan, with drugs that affect the RAAS, such as ACE inhibitors or aliskiren, is not recommended; if such therapy is necessary, blood pressure, renal function, and blood plasma electrolyte levels should be carefully monitored. Concomitant use of ARB II, including valsartan, with drugs containing aliskiren is contraindicated in patients with diabetes mellitus and/or with moderate or severe renal impairment (GFR less than 60 ml/min/1.73 m2 body surface area) and is not recommended in other patients.
The simultaneous use of ARB II with ACE inhibitors is contraindicated in patients with diabetic nephropathy and is not recommended in other patients.
Hyponatremia and/or dehydration
In patients with severe hyponatremia and/or dehydration, for example, due to taking large doses of diuretics, in rare cases, arterial hypotension with clinical manifestations may develop at the beginning of therapy with Valsacor®. Before starting treatment, it is recommended to restore sodium levels and/or replenish blood volume, in particular by reducing the doses of diuretics.
If arterial hypotension with clinical manifestations develops, the patient must be placed in a horizontal position and, if necessary, a 0.9% sodium chloride solution should be administered intravenously. Therapy with Valsacor® can be continued only after stabilization of hemodynamic parameters.
Hyperkalemia
Concomitant use of potassium-sparing diuretics (spironolactone, eplerenone, triamterene, amiloride), potassium supplements, potassium-containing nutritional supplements or other drugs that can increase serum potassium levels (for example, heparin) is not recommended. It is necessary to monitor the potassium content in the blood plasma.
Renal artery stenosis
Short-term use of valsartan in patients with renovascular hypertension, which developed secondary to unilateral stenosis of the artery of a single kidney, was not accompanied by significant changes in renal hemodynamics, creatinine concentrations or serum urea nitrogen. Because other drugs that affect the RAAS can increase serum urea and creatinine concentrations in patients with bilateral renal artery stenosis or solitary renal artery stenosis, continuous monitoring of these values is recommended as a precaution.
Condition after kidney transplantation
The safety of Valsacor® in patients who have recently undergone kidney transplantation has not been established.
Primary hyperaldosteronism
Patients with primary hyperaldosteronism are resistant to antihypertensive drugs that affect the RAAS, therefore the use of Valsacor® is not recommended for such patients.
Stenosis of the aortic and/or mitral valves, HOCM
The drug Valsacor® should be used with caution in patients with hemodynamically significant stenosis of the aortic and/or mitral valves or with HOCM.
Renal dysfunction
In patients with impaired renal function, no change in drug doses is required, since there is no data on the use of the drug Valsacor® in severe renal failure (creatinine clearance less than 10 ml/min or 0.167 ml/s) and in patients on hemodialysis, in such cases In cases, the drug is recommended to be used with caution. Concomitant use of ARB II, including valsartan, or ACE inhibitors with aliskiren is contraindicated in patients with impaired renal function (GFR less than 60 ml/min/1.73 m2 body surface area).
Liver dysfunction
For patients with impaired liver function, biliary cirrhosis and cholestasis, Valsacor® at a dosage of 320 mg is contraindicated, since the maximum daily dose should not exceed 80 mg.
History of angioedema
Among patients with angioedema (swelling of the larynx and vocal cords, causing obstruction of the airways and/or swelling of the face, lips, pharynx and/or tongue) during treatment with Valsacor®, cases of development of angioedema in the anamnesis were observed, including when taking ACE inhibitors. If angioedema develops, the drug should be immediately discontinued and the possibility of its re-use should be excluded.
Arterial hypertension
For hypertension, the drug Valsacor® can be used in monotherapy or simultaneously with other antihypertensive drugs, in particular with diuretics.
CHF/increasing survival of patients with acute myocardial infarction
It is possible to use the drug Valsacor® in combination with other drugs used for acute myocardial infarction (thrombolytics, acetylsalicylic acid as an antiplatelet agent, beta-blockers and HMG-CoA reductase inhibitors (statins)).
The simultaneous use of Valsacor® and ACE inhibitors in this category of patients is not recommended, since this combination therapy does not lead to additional clinical effect and is accompanied by an increased risk of developing AEs compared to therapy with the two drugs separately.
In patients with CSP, triple combination therapy (with Valsacor®, an ACE inhibitor and a beta-blocker) is not recommended, since it does not lead to additional clinical effect and is accompanied by an increased risk of developing AEs.
The use of Valsacor® in patients with CHF or acute myocardial infarction often leads to a slight decrease in blood pressure. As a rule, discontinuation of the drug is not required if dosing instructions are followed.
In patients whose renal function may depend on the activity of the RAAS (for example, in patients with CHF II-IV FC according to the NYHA classification), therapy with ACE inhibitors and ARB II is accompanied by oliguria and/or an increase in azotemia, and in rare cases, AKI and/or death outcome. Since valsartan is a II ARA, the possibility of deterioration of renal function with its use cannot be excluded.
Initiation of therapy in patients with XCII or acute myocardial infarction should be done with caution. Renal function should always be assessed when assessing patients.
Special information on excipients
The drug Valsacor® contains lactose, therefore the drug is contraindicated in patients with lactase deficiency, lactose intolerance, and glucose-galactose malabsorption syndrome.
Interactions of the drug Valsacor
For patients after myocardial infarction, Valsacor can be taken in combination with other drugs, such as thrombolytics, acetylsalicylic acid, beta-adrenergic blockers or statins. When Valsacor is used in combination with potassium-sparing diuretics (such as spironolactone, triamterene, amiloride), potassium preparations or salt substitutes that contain potassium, an increase in the concentration of potassium in the blood serum may occur. There were no signs of clinically significant interaction between Valsacor and other drugs. In clinical studies, drugs such as cimetidine, warfarin, furosemide, digoxin, atenolol, indomethacin, hydrochlorothiazide, amlodipine, and glibenclamide were studied. Since Valsacor does not undergo significant metabolism, it is unlikely that clinically significant interactions in the form of metabolic induction or inhibition of the cytochrome P450 system will occur. Valsartan binds well to plasma proteins, but in vitro did not indicate any interactions at this level with molecules that are also highly protein bound (diclofenac, furosemide or warfarin).
Valsacor: use according to instructions
The drug is taken as prescribed by a cardiologist for the following pathologies:
- heart failure of non-acute severity: with functional disorders while maintaining a stable physical condition and during periods of remission;
- after a heart attack, with persisting dysfunction of the left ventricle of the myocardium;
- chronic heart failure without correction of the condition with ACE inhibitors;
Valsacor N and ND are prescribed in cases of hypertension as part of complex treatment.
The treatment regimen depends on the existing health problems:
- average daily dosage at the initial stage: 20–40 mg of the drug twice a day;
- if necessary, the dose of the drug is increased to 160 mg per day;
- The maximum dose of medication per day is 320 mg.
The tablets are taken with a sufficient amount of water, regardless of meal time. There is no need to chew or crush the medicine beforehand. Valsacor is used for long-term correction of physical condition. The general course of its use is at least several months. If side effects are detected, the dose of the drug is reduced or it is recommended to buy a similar antihypertensive drug.
