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Aprovel (UK), Avapro
Pharmacologic class: Angiotensin II receptor antagonist
Therapeutic class: Antihypertensive
Pregnancy risk category D
FDA Box Warning
• When used during second or third trimester of pregnancy, drug may cause fetal injury and even death. Discontinue as soon as pregnancy is detected.
Blocks aldosterone-secreting and potent vasoconstrictive effects of angiotensin II at tissue receptor sites, which reduces vasoconstriction and lowers blood pressure
Tablets: 75 mg, 150 mg, 300 mg
⊘Indications and dosages
Adults: 150 mg/day P.O.; may increase to 300 mg/day
➣ Nephropathy in patients with type 2 diabetes and hypertension
Adults: 300 mg P.O. once daily
• Volume-depleted or hemodialysis patients receiving diuretics
• Hypersensitivity to drug or its components
Use cautiously in:
• heart failure, volume or sodium depletion, renal disease, hepatic impairment
• black patients
• females of childbearing age
• pregnant or breastfeeding patients
• children ages 18 and younger (safety not established).
• Administer with or without food.
• Know that drug may be given with other antihypertensive drugs.
CNS: dizziness, fatigue, headache, syncope
CV: orthostatic hypotension, chest pain, peripheral edema
EENT: conjunctivitis, vision disturbance, ear pain, sinus disorders
GI: nausea, diarrhea, constipation, abdominal pain, dry mouth
GU: albuminuria, renal failure
Metabolic: gout, hyperkalemia
Musculoskeletal: joint pain, back pain, muscle weakness
Respiratory: upper respiratory tract infection, cough, bronchitis
Other: dental pain
Drug-drug.Diuretics, other antihypertensives: increased risk of hypotension
Lithium: increased lithium blood level
Nonsteroidal anti-inflammatory drugs: decreased antihypertensive effects
Potassium-sparing diuretics, potassium supplements: increased risk of hyperkalemia
Drug-diagnostic tests.Albumin: increased level
Drug-food.Salt substitutes containing potassium: increased risk of hyperkalemia
• Monitor vital signs, especially blood pressure.
• Watch for signs and symptoms of orthostatic hypotension.
• Watch blood pressure closely when volume depletion may cause hypotension (as in diaphoresis, nausea, vomiting, diarrhea, and postoperative period).
• Assess fluid intake and output. Keep patient well hydrated, especially if he's receiving diuretics concurrently.
• Monitor blood urea nitrogen and creatinine levels.
• Tell patient he may take with or without food.
• Instruct patient to change position slowly and to stay well hydrated, to minimize blood pressure decrease when rising.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Tell female patient that drug has been linked to fetal injury and deaths. Caution her not to get pregnant during therapy. Advise her to use barrier contraception.
• Instruct female patient to report pregnancy.
• Instruct patient to report fever, chills, dizziness, severe vomiting, diarrhea, and dehydration.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.
Pharmacologic: angiotensin ii receptor antagonists
Time/action profile (antihypertensive effect with chronic dosing)
|PO||within 2 hr||2 wks||24 hr|
Adverse Reactions/Side Effects
Central nervous system
- chest pain
- abdominal pain
- impaired renal function
Fluid and Electrolyte
- hyperkalemia (most frequent)
- angioedema (life-threatening)
Drug-Drug interactionNSAIDs and selective COX-2 inhibitors may blunt the antihypertensive effect and ↑ the risk of renal dysfunction.Additive hypotension with other antihypertensives.Excessive hypotension may occur with concurrent use of diuretics.Concurrent use of potassium-sparing diuretics, potassium-containing salt substitutes, or potassium supplements may ↑ risk of hyperkalemia.↑ risk of hyperkalemia, renal dysfunction, hypotension, and syncope with concurrent use of ACE inhibitors or aliskiren ; avoid concurrent use with aliskiren in patients with diabetes or CCr <60 mL/minMay ↑ the levels/effects of amiodarone,fluoxetine,glimeperide, glipizide,phenytoin,rosiglitazone,warfarin.
Availability (generic available)
- Assess BP (lying, sitting, standing) and pulse frequently during initial dose adjustment and periodically during therapy. Notify.health care professional of significant changes.
- Monitor frequency of prescription refills to determine compliance.
- Assess patients for signs of angioedema (dyspnea, facial swelling). May rarely cause angioedema.
- Lab Test Considerations: Monitor renal function. May cause ↑ BUN and serum creatinine.
- May cause hyperkalemia.
- May cause slight ↓ hemoglobin.
Potential Nursing DiagnosesRisk for injury (Adverse Reactions)
Noncompliance (Patient/Family Teaching)
- Correct volume depletion, if possible, before initiation of therapy.
- Oral: Administer once daily without regard to food.
- Emphasize the importance of continuing to take as directed, even if feeling well. Take missed doses as soon as remembered if not almost time for next dose; do not double doses. Instruct patient to take medication at the same time each day. Warn patient not to discontinue therapy unless directed by health care professional.
- Caution patient to avoid salt substitutes containing potassium or foods containing high levels of potassium or sodium unless directed by health care professional. See.
- Caution patient to avoid sudden changes in position to decrease orthostatic hypotension. Use of alcohol, standing for long periods, exercising, and hot weather may increase orthostatic hypotension.
- May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to avoid concurrent use of Rx, OTC, and herbal products, especially NSAIDs and cough, cold, or allergy medications, without consulting health care professional.
- Instruct patient to notify health care professional of medication regimen before treatment or surgery.
- Instruct patient to notify health care professional if swelling of face, eyes, lips, or tongue or if difficulty swallowing or breathing occur.
- Advise women of childbearing age to use contraception and notify health care professional if pregnancy is planned or suspected, or if breastfeeding. Irbesartan should be discontinued as soon as possible when pregnancy is detected.
- Emphasize the importance of follow-up exams to evaluate effectiveness of medication.
- Hypertension: Encourage patient to comply with additional interventions for hypertension (weight reduction, low-sodium diet, discontinuation of smoking, moderation of alcohol consumption, regular exercise, stress management). Medication controls but does not cure hypertension.
- Instruct patient and family on proper technique for monitoring BP. Advise them to check BP at least weekly and to report significant changes.
- Decrease in BP without appearance of excessive side effects.
- Delayed progression of diabetic nephropathy in patients with type 2 diabetes.