Indications for DIOVAN HCT:
Take once daily. Add-on or initial therapy and not volume-depleted: initially 160mg/12.5mg; may increase after 1–2 weeks up to max 320mg/25mg. Maximum effects within 2–4 weeks after dose change. May be substituted for the titrated components.
Anuria. Sulfonamide allergy. Concomitant aliskiren in patients with diabetes.
Fetal toxicity may develop; discontinue if pregnancy is detected. Intravascular volume depletion; do not use as initial therapy. Correct salt/volume depletion before starting, or monitor closely. Monitor renal function in renal artery stenosis, chronic kidney disease, severe CHF, or volume depletion. Diabetes. Gout. Asthma. Hypercalcemia. SLE. Acute myopia. Secondary angle-closure glaucoma. Monitor electrolytes. Liver disease. Severe renal impairment (CrCl ≤30mL/min): not established. Neonates. Pregnancy: avoid. Nursing mothers: not recommended.
Angiotensin II receptor blocker (ARB) + thiazide diuretic.
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. Antagonized by cholestyramine, colestipol resins. 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 (CrCl <60mL/min): not recommended. 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). Orthostatic hypotension may be potentiated by alcohol, barbiturates, narcotics, antihypertensives. May be potentiated by inhibitors of OATP1B1 (eg, rifampin, cyclosporine) or MRP2 (eg, ritonavir). Potentiates nondepolarizing muscle relaxants. Adjust antidiabetic, antigout medications. Hyperuricemia may be potentiated by cyclosporine. May increase toxicity of digitalis, lithium (monitor). Possible symptomatic hyponatremia with carbamazepine.
Headache, dizziness, nasopharyngitis, fatigue, cough, diarrhea, orthostatic hypotension, electrolyte disturbances (eg, hypokalemia, hyponatremia, hypomagnesemia), hyperuricemia, increased serum cholesterol or triglycerides; rare: rhabdomyolysis; HCTZ: increased risk for non-melanoma skin cancer.