Exforge: Uses, Side Effects, Dosage &

By Miriatu


Exforge refers to the combination of two prescription medicines; Amlodipine and Valsartan. Of which   amlodipine appears to be a calcium channel blocker, which works by relaxing the muscles of the heart and blood vessels. While Valsartan on its part, is an angiotensin II receptor antagonist. It keeps blood vessels from narrowing away, thus lowering blood pressure and improving blood flow. Let’s take a short look at what these two drugs really are.


What is amlodipine?

Amlodipine refers to a calcium channel blocker, which dilates (widens) blood vessels and improves the flow of blood.

It can be used to treat chest pain (angina) and other conditions caused by coronary artery disease.

It is also used to treat high blood pressure (hypertension). Lowering blood pressure may also lower your risk of having a stroke or heart attack.

Amlodipine is being used by both adults and children who are at least 6 years of age.

Before you start taking amlodipine, tell your doctor, particularly if you have congestive heart failure or liver disease.

 Also, drinking alcohol can further lower your blood pressure and may consequently increase certain side effects of amlodipine.

If you are being treated for high blood pressure, you should keep using amlodipine even if you feel well. High blood pressure in most cases often has no symptoms.  So you may need to use blood pressure medication for the rest of your life.

Amlodipine only occurs as part of a complete program of treatment (as mentioned above) that may also include problems of diet, exercise, weight control problems, and other medications.  So you need to continue following your diet, medication, and also exercise routines very closely.

Your chest pain may become worse when you first start taking amlodipine or when your dose is increased. Make sure you call your doctor if your chest pain is severe or ongoing.


What is Valsartan?

Valsartan on the other hand is an oral medication that is used to treat high blood pressure and also congestive heart failure. It belongs to a particular class of drugs called angiotensin receptor blockers (ARBs), which includes also irbesartan (Avapro), losartan (Cozaar), and also candesartan (Atacand) angiotensin, that is formed in the blood by the action of angiotensin converting enzyme (ACE), is a strong chemical that usually attaches to angiotensin receptors which are found in many tissues but are primarily on smooth muscle cells of blood vessels. The attachment of Angiotensin to the receptors causes the blood vessels to narrow (vasoconstrict) which then leads to an increase in blood pressure (hypertension). Valsartan also blocks the angiotensin receptor. This is done by blocking the action of angiotensin; Valsartan opens blood vessels and reduces blood pressure. Valsartan was approved by the FDA around December 1996.

So as earlier mentioned above, it is the combination of these two drugs that makes up Exforge, which is used for the treatment of high blood pressure.


Which drug can interact with Valsartan?

To combine Valsartan with potassium-sparing diuretics (for example spironolactone (Aldactone), and triamterene, potassium supplements, or even salt substitutes containing potassium may lead to hyperkalemia (elevated potassium in the blood) and it increases serum creatinine, a blood test used for monitoring function of the kidneys in heart failure patients. Combining Valsartan or other ARBs with no steroidal anti-inflammatory drugs (NSAIDs) in elderly patients, fluid-depleted (including those on diuretic therapy), or those with poor kidney function may lead to reduced kidney function, this may include kidney failure. These effects are usually reversible. There have always been reports that aspirin and other NSAIDs such as ibuprofen (Advil, Medipren, Motrin, Nuprin, etc.), indomethacin may reduce the effects of ARBs.


What is high blood pressure? It will seem somehow crazy if we go ahead and talk about the treatment of high blood pressure when we don’t really understand what is meant by high blood pressure. Hypertension or high blood pressure is a medical condition that occurs when there is an increase in blood pressure, especially to an unhealthy level.  The blood pressure measurement always takes into consideration, how fast blood can pass through your vein and the amount of resistance that the blood meets while it’s pumping. This hypertension may develop over the course of several years. You may not notice any symptoms during these years, though without symptoms, it can still cause damage to your blood vessels. It is always important to monitor and regular blood pressure readings. This way, it will be easy for early detection of hypertension, which will go a long way to early prevention or treatment.

Hypertension prevention and treatment involves both prescription medicines as mentioned earlier   and also a healthy lifestyle.


Possible causes of Hypertension

Since there are two types of hypertension, they both have different causes.

1.    Primary hypertension

 This is also called essential hypertension. It always develops with no identifiable cause over time. Since there is still some sort of controversy as to why blood pressure should gradually increase, researchers have come to look at some possible causes of the primary hypertension

Environment: some unhealthy lifestyle choices such as the lack of physical activities, including poor diet can contribute to take their toll on your body. Some lifestyles may lead to weight problems which might result to high risk of hypertension.

Physical changes: this situation might occur to some people as a result of some malfunctions in the body

Genes:  hypertension may also result from genetically predisposed hypertension, which may come from gene mutations or inherited genetic abnormalities from your parents


2.    Secondary hypertension.

The secondary hypertension often occurs faster and it’s more often than not, more severe than the primary hypertension. Several conditions accounts to secondary hypertension such as obstructive sleep apneal, use of illegal drugs, the abuse of alcohol, adrenal gland problems, endocrine tumors and sometimes kidney diseases etc.


Uses of Exforge

Exforge is mainly used to treat high blood pressure. So the main uses of Exforge are to lower high blood pressure in order to prevent stroke, heart attacks and kidney problems as mentioned above.

Exforge HCT can be used to control high blood pressure (hypertension).

Everybody has blood pressure. This pressure helps to get your blood all around your body. Blood pressure may be different at particular times of the day; it depends on how busy or worried you are. You may have hypertension (high blood pressure) when your blood pressure gets higher than is needed in the body, even at a time when you are calm and relaxed.

High blood pressure can also contribute to the increase in the workload of the heart and blood vessels. If the situation continues for a long period of time, it can automatically damage the blood vessels in the brain, heart and kidneys. This might result to stroke, and heart or kidney failure. High blood pressure also increases the risk of having heart attacks. Lowering of your blood pressure as one of the Exforge uses, may help to reduce the chance of these disorders happening.

Exforge HCT contains three drugs which are amlodipine besylate drug, Valsartan drug and hydrochlorothiazide drug. These medicines combined, as some of the Exforge uses, to reduce blood pressure in three different ways that clear show the distinctive uses of Exforge.

  • Amlodipine besylate block the movement of calcium from going into the cells of the heart and blood vessels. As a result, they then relax blood vessels and increase the supply of blood and oxygen to the heart thereby reducing its workload.
  • Valsartan helps to block the effect of angiotensin II, which is a substance in the body that works by tightening blood vessels and makes your blood pressure to rise.  Also, when the effect of angiotensin II is blocked, your blood vessels will relax and then will cause your blood pressure to go down.
  • Hydrochlorothiazide which acts as one of the uses of Exforge, helps in reducing the total amount of excess fluid found in the body by increasing the amount of urine produced by the body; this will help to lower your blood pressure.


Who can and who cannot use Exforge.

Pregnant women

Looking at the uses of Exforge, pregnant women are not advised to use Exforge during pregnancy because it might harm the unborn baby. If you are using Exforge and find out that you are pregnant, stop taking it and report to your doctor immediately

Nursing/Breastfeeding Women

There is no clinical evidence to show whether or not amlodipine and Valsartan are able to pass into breast milk, or if it could be of harm to a nursing baby. However, nursing women should seek the doctor’s advice before using Exforge.

Diabetic patients: Looking at Exforge uses, Diabetic patients should not use Exforge or take any medicine having aliskiren.

Those who are allergic to amlodipine should not also take Exforge.

Those with kidney diseases should not take Exforge with aliskiren. In case of doubt, inform your doctor about your situation, especially if you have some diseases like liver diseases, heart failure, diabetes, chest pain, if you are vomiting or having diarrhea, and if you ever had a heart attack, if you have always been taking blood pressure medication


Taking this Medication

All drugs, including Exforge should be taken exactly as prescribed by the doctor. However, here are some advises associated with taking this drug.

  • Exforge should not be taken in quantity larger or smaller than the doctor’s prescribed amounts, and also should not be taken for longer than the prescribed duration.
  • Exforge should always be taken with a glass full of water or as directed by your healthcare provider
  • In case of surgery, make sure you inform your doctor if you have been using Exforge
  • It is required to always read all medication guide and instruction sheets provided to you and to ask your doctor in case of any clarification.
  • If you happen to take too much Exforge, maybe because of some mistake, or misidentification of drugs, immediately call your doctor or any poison control center, or go to the emergency room.
  • If you are about to or planning for a kidney dialysis, tell all your doctors that you are taking exforge.
  • Potassium supplements or salt substitutes should not be taken while taking Exforge unless recommended by the doctor


Side effects of Exforge

 EXFORGE on its part may cause serious side effects which may include the fact that:

  • Exforge causes serious malfunctions to an unborn baby, including injury and can also be associated to increase infant mortality rate. All these can happen due to Exforge side effects
  • Exforge can also cause low blood pressure (hypotension). This is most likely to happen if you happen to take water pills, are on a low-salt diet, get dialysis treatments, have heart problems, get sick with vomiting or diarrhea, or drink alcohol. Lie down if you feel that your body is weak or dizzy. Call your doctor right away if you witness any of these Exforge side effects
  • Exforge can easily lead to more heart attacks and chest pain (angina) in people that already have had some severe heart complications. This usually occurs at the onset of EXFORGE use or when there is an increase in your dose of EXFORGE. Get emergency help immediately if the situation gets worse.
  • Chest pain or chest pain that does not go away, can also occur as possible Exforge side effects
  • Kidney problems: As part of the side effects of Exforge, kidney problems may become worse in people that already have kidney problems. Some people may have changes in blood tests for kidney function and may also need a lower dose of EXFORGE. Call your doctor if you notice some Exforge side effects such as swelling in your feet, ankles, or hands or in case of an unusual weight gain. If you have heart failure, your doctor should check the functioning of your kidney before prescribing EXFORGE.
  • Looking further to other side effects of Exforge, some laboratory blood test may have some changes in people suffering from heart failure. Some people who realize that they do have heart failure, and who take Valsartan, one of the components in EXFORGE, has changes in blood tests which may include increased potassium and of course decreased kidney function.
  • The most common, but also less severe side effects of Exforge include: swelling (edema) of the hands, ankles, or feet, fast or pounding heart eats, dizziness, some cold symptoms like stuffy nose, sneezing, sore throat. All these Exforge side effects if quickly notified can be easily taken care of or remedy.


Minor Side Effects of EXFORGE

Some of the side effects of Exforge that can occur with amlodipine / Valsartan may not need medical attention. As your body adjust to the medicine during the treatment duration, these side effects may go away. Your health care professional may also in one way or the other be able to inform you about the various ways to reduce or prevent some of these minor side effects. If any of the side effects continue,  or if you have any questions concerning the side effects that you are witnessing, check with your health care professional. Such side effects may include back pain, belching bone pain, difficulty with moving, feeling sad, heartburn, noise in the ear, low degree of erection, irritability, loss or lack of strength, loss of interest or pleasure, muscle cramping, pain in the arms or legs, pressure in the stomach, tiredness, toothache, skin rash, unusual skin warm, watering of the eyes.


 Dosage of Exforge

For a drug to function well, it all depends on the way the patient respected the dose, failure of which can be so catastrophic, as the same drug that was made to heal can also kill. For the initial dosage of Exforge, it can be taken once-daily. The dosage of Exforge may also be increased after a therapy of 2 weeks. The lowering effect of full blood pressure was somehow achieved 2 weeks after being on the maximal dosage of Exforge HCT. The highest maximum recommended dose of Exforge HCT is probably 10/320/25 mg.

Exforge HCT may also be used for patients who are not adequately controlled on any two of the following classes of anti-hypertension: calcium channel blockers, angiotensin receptor blockers, and also diuretics.

Effects of high dose

Also looking at the dosage of Exforge, a patient who may experience dose-limiting adverse reactions to a particular component while on any combination of the components of Exforge HCT, maybe switch to Exforge HCT having a lower dosage of Exforge of that component in order to achieve the reduction of similar blood pressure.

A patient whose blood pressure may not be adequately controlled with amlodipine (or another dihydropyridine calcium-channel blocker) alone or with Valsartan (or other angiotensin II receptor blocker) alone may be switched to a combination therapy with Exforge, as a means to regulate Exforge dosage

Another patient who experiences dose-limiting adverse reactions on either component alone may also be switched to Exforge containing a much more relatively lower Exforge dosage dose of that component in combination with the other so as to achieve some similar blood pressure reductions.  In this case, the clinical response to Exforge should as well be evaluated on subsequent basses, and if blood pressure remains uncontrolled after 3 to 4 weeks of therapy, the dose may be titrated to a maximum of 10/320 mg.

Initial dose: for the initial dose, based on its effectiveness and tolerance for each individual component, The dose made for each component is amlodipine 5 mg to 10 mg orally, taken once daily and Valsartan 160 mg to 320 mg orally, also once daily.
In general, the antihypertensive effectiveness increases with increase in dose

Hypotension an Excessive hypotension has been seen in 0.4% of patients with uncomplicated hypertension treated with Exforge in placebo-controlled studies. In most patients with an activated renin-angiotensin system, the likes of volume- and/or salt depleted patients taking high doses of diuretics, symptomatic hypotension may always occur in patients getting angiotensin receptor blockers. Volume depletion should always be corrected prior to the administration of Exforge, or before Exforge is administered. Treatment with Exforge must always start under close medical supervision. Therapy caution should be initiated in patients with heart failure or having a recent myocardial infarction. And also in patients who are undergoing some surgery or dialysis, Patients with heart failure or situations of post-myocardial infarction. Patients who are given Valsartan will commonly have some reduction in blood pressure, but discontinuation of their therapy because of continuing symptomatic hypotension is not usually necessary when dosing instructions are followed by the patient. In the case of controlled trials in patients having heart failure, the incidence of hypotension in Valsartan-treated patients was at 5.5% as compared to 1.8% occurring in placebo-treated cases. In the Valsartan at the level of Acute Myocardial Infarction Trial (VALIANT), hypotension in some post-myocardial infarction patients led to a permanent discontinuation of therapy in about 1.4% of Valsartan-treated patients and about 0.8% of captopril-treated patients. Since the level of vasodilation induced by amlodipine is always gradual at the onset, acute hypotension has rarely been reported after a good oral administration. Nonetheless, there should be a caution, as with any other peripheral vasodilator, should always be exercised when amlodipine is being administered, especially in patients suffering from severe aortic stenosis. If there is excessive hypotension with Exforge, the patient should always be placed in a flat position and, given an intravenous infusion of normal saline if need be. Also, a transient hypotensive response is not a contraindication to more treatment, which can usually be continued without any difficulty once the blood pressure has stabilized.

Still, as far as dosing is concerned, there is usually a very high Risk of Myocardial Infarction or Increased Angina. Worsening angina and also acute myocardial infarction can develop after beginning or increasing the regular dose of amlodipine, mostly in patients with severe obstructive coronary artery disease.


Renal impairment

 About 5.4 Impaired Renal Functional Changes occurring in renal function, including acute renal failure in one way or the other, can be caused mostly by drugs that inhibit the renin-angiotensin system and by diuretics.  Most Patients whose renal function may depend in part on the activity of the renin angiotensin system (for example, patients suffering from renal artery stenosis, chronic kidney complications, severe congestive heart failure, or volume depletion) may find themselves in a particular risk of developing acute renal failure on Exforge.

Renal functions should be monitored periodically, especially in these types of cases. Also consider withholding or better still discontinuing therapy in patients who may develop an unusual clinically significant decrease in renal function on Exforge. 5.5 Hyperkalemia Drugs that inhibit the renin-angiotensin system can also cause hyperkalemia. Try to monitor serum electrolytes periodically. Some patients who may have heart failure will have developed increases in potassium with Valsartan therapy. These effects are usually somehow minor and transient, and they are also more likely to occur in patients with pre-existing renal impairment. At this level, Dosage reduction and/or discontinuation of Exforge may be required in this situation.


A disclaimer: Note that this article only serves as a guide and should for no reason be used to replace medical advice or a doctor’s prescription. You are recommended to always talk to a pharmacist or doctor whenever you have any doubt or start using

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