Avapro

Av·a·pro (v-pr)

A trademark for the drug irbesartan.

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irbesartan

Aprovel (UK), Avapro

Pharmacologic class: Angiotensin II receptor antagonist

Therapeutic class: Antihypertensive

Pregnancy risk category C (first trimester), D (second and third trimesters)

FDA Boxed 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.

Action

Blocks aldosterone-secreting and potent vasoconstrictive effects of angiotensin II at tissue receptor sites, which reduces vasoconstriction and lowers blood pressure

Availability

Tablets: 75 mg, 150 mg, 300 mg

⊘Indications and dosages

➣ Hypertension

Adults: 150 mg/day P.O.; may increase to 300 mg/day

Children ages 13 to 16: 150 mg/day P.O.; may increase to 300 mg/day

Children ages 6 to 12: 75 mg/day P.O.; may increase to 150 mg/day

➣ Hypertension in volume-depleted or hemodialysis patients receiving diuretics

Adults: Initially, 75 mg/day P.O.

Off-label uses

• Nephropathy in patients with type 2 diabetes and hypertension

Contraindications

• Hypersensitivity to drug
• Bilateral renal artery stenosis
• Pregnancy (second and third trimesters)

Precautions

Use cautiously in:
• heart failure, volume or sodium depletion, renal disease, hepatic impairment
• black patients
• females of childbearing age
• breastfeeding patients
• children ages 18 and younger (safety not established).

Administration

• Administer with or without food.
• Know that drug may be given with other antihypertensive drugs.

Route	Onset	Peak	Duration
P.O.	Unknown	Within 2 hr	24 hr

Adverse reactions

CNS: dizziness, fatigue, headache, syncope

CV: orthostatic hypotension, chest pain, peripheral edema

EENT: 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

Interactions

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

Patient monitoring

• 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.

Patient teaching

• 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.

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Avapro®

Irbesartan Cardiovascular disease A once-daily angiotensin II receptor antagonist used for treating HTN. See Hypertension.