irbesartan

irbesartan /ir·be·sar·tan/ (ir″bĕ-sahr´tan) an angiotensin II receptor antagonist used as an antihypertensive.

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ir·be·sar·tan (rb-särtn)

n.

An oral drug that is an angiotensin II receptor antagonist used to treat hypertension.

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irbesartan,

an antihypertensive.

indications It is used to treat hypertension, either alone or in combination with other drugs. It is also used investigationally to treat heart failure and hypertension in patients with diabetic nephropathy caused by type 2 diabetes mellitus.

contraindications Known hypersensitivity and second- and third-trimester pregnancy prohibit its use.

adverse effects Anxiety, headache, fatigue, diarrhea, and dyspepsia are among the adverse effects. Common side effects include dizziness, cough, and upper respiratory infection.

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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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irbesartan

Avapro^® Cardiology An ACE inhibitor used to manage HTN Lab ↑ in BUN Adverse effects Diarrhea, dyspepsia, musculoskeletal fatigue, URIs Contraindications Impaired renal function. See Hypertension. Cf Losartan.