eprosartan mesylate
Pharmacologic class: Angiotensin II receptor antagonist
Therapeutic class: Antihypertensive
Pregnancy risk category C (first trimester), D (second and third trimesters)
Action
Blocks aldosterone-stimulating and vasoconstrictive effects of angiotensin II at receptor sites in vascular smooth muscles and adrenal glands, decreasing vascular resistance
Availability
Tablets: 400 mg, 600 mg
Indications and dosages
➣ Hypertension
Adults: 600 mg P.O. once daily or in divided doses b.i.d. Total daily dosage range is 400 to 800 mg.
Contraindications
• Hypersensitivity to drug or its components
• Pregnancy or breastfeeding
Precautions
Use cautiously in:
• hypotension, heart failure, renal or hepatic impairment, obstructive biliary disorders, volume or sodium depletion
• concurrent high-dose diuretic therapy
• females of childbearing age
• children younger than age 18 (safety not established).
Administration
• Give initial dose in supervised medical setting, and monitor blood pressure for 2 hours after administration.
• Know that drug may be given alone or with other antihypertensives.
• Be aware that black patients have a higher risk of angioedema.
• Be prepared to treat transient hypotension by placing patient in supine position and giving I.V. normal saline infusion as needed.
Adverse reactions
CNS: dizziness, fatigue, headache, syncope
CV: hypotension, chest pain, peripheral edema
EENT: sinus disorders
GI: nausea, diarrhea, constipation, abdominal pain, dry mouth
GU: albuminuria, renal failure
Hepatic: hepatitis
Metabolic: gout, hyperkalemia
Musculoskeletal: joint pain, back pain, muscle weakness
Respiratory: upper respiratory tract infection, cough, bronchitis
Skin: angioedema
Other: dental pain, fever, facial edema
Interactions
Drug-drug. Antihypertensives, diuretics: increased risk of hypotension
Nonsteroidal anti-inflammatory drugs: decreased antihypertensive effect of eprosartan
Potassium-sparing diuretics, potassium supplements: increased risk of hyperkalemia
Drug-diagnostic tests. Absolute neutrophil count, hemoglobin, platelets, white blood cells: decreased
Albumin, creatinine, liver function tests, serum BUN: elevated levels
Drug-food. Salt substitutes containing potassium: increased risk of hyperkalemia
Drug-herbs. Ephedra (ma huang): antagonism of eprosartan action
Drug-behaviors. Alcohol use: increased CNS depression
Patient monitoring
• Monitor vital signs, particularly for hypotension after administration.
• Assess cardiovascular status, especially for chest pain, syncope, and edema.
• Monitor liver and kidney function test results, watching for drug-induced hepatitis or renal failure.
• Assess respiratory status. Stay alert for dry, persistent cough and signs and symptoms of respiratory infections.
• Monitor electrolyte levels, and watch for signs and symptoms of hyperkalemia.
Patient teaching
• Instruct patient to take drug at same time each day, with or without food.
☞ Inform patient that drug may cause angioedema. Instruct him to immediately report facial or lip swelling, fever, or sore throat.
☞ Advise patient to immediately report chest pain, fainting, decreased urine output, unusual tiredness, yellowing of skin or eyes, or swelling.
☞ Tell female patient to contact prescriber right away if she suspects she's pregnant.
• Caution female not to breastfeed while taking drug.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.