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Pharmacologic class: Angiotensin II type 1-receptor antagonist
Therapeutic class: Antihypertensive
Pregnancy risk category C (first trimester), D (second and third trimesters)
FDA Box Warning
• When used during second or third trimester of pregnancy, drug may cause fetal harm or death. Discontinue as soon as possible when pregnancy is detected.
Selectively blocks binding of angiotensin II to specific tissue receptors in vascular smooth muscle and adrenal gland. This action blocks vasoconstrictive effects of renin-angiotensin system as well as aldosterone release, thereby reducing blood pressure and possibly preventing vascular remodeling related to arteriosclerosis.
Tablets: 5 mg, 20 mg, 40 mg
Indications and dosages
Adults and children ages 6 to 16 weighing more than 35 kg (77 lb): 20 mg P.O. once daily; may titrate to 40 mg daily after 2 weeks, if needed
Children ages 6 to 16 weighing 20 kg (44 lb) to less than 35 kg (77 lb): 10 mg P.O. daily; may titrate to 20 mg daily after 2 weeks, if needed.
• Volume depletion
• Hypersensitivity to drug or its components
Use cautiously in:
• hepatic disease, renal dysfunction, hypovolemia, sodium depletion
• elderly patients
• pregnant patients (first trimester; not recommended in second and third trimesters)
• breastfeeding patients
• children (safety and efficacy not established).
• Give with or without food.
• Know that drug may be used alone or with other antihypertensives.
CNS: fatigue, dizziness, headache, insomnia
CV: orthostatic hypotension, chest pain, peripheral edema, syncope, tachycardia
EENT: sinusitis, rhinitis, pharyngitis
GI: nausea, diarrhea, constipation, abdominal pain, dry mouth
Musculoskeletal: back pain, arthritis, muscle weakness
Respiratory: upper respiratory infection symptoms, bronchitis, cough
Skin: dry skin, rash, inflammation, pruritus, alopecia, angioedema
Other: dental pain, flulike symptoms
Drug-diagnostic tests. Triglycerides: increased level
Drug-herbs. Ephedra (ma huang): antagonism of antihypertensive effect
• Monitor vital signs and cardiovascular status. Stay alert for orthostatic hypotension, syncope, and peripheral edema.
• Check temperature and watch for signs and symptoms of flu and other infections (especially respiratory and EENT infections).
• Watch for angioedema.
• In volume-depleted patient, monitor blood pressure carefully after initial dose. Transient blood pressure drop may occur.
• Tell patient to take at same time each day, with or without food.
• Advise patient to promptly report signs and symptoms of infection, particularly respiratory symptoms.
• Inform patient that when he begins therapy, inadequate fluid intake, excessive perspiration, vomiting, or diarrhea may cause blood pressure to drop. Tell him to change position slowly to avoid dizziness or fainting.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
☞ Tell female patient to notify pre-scriber immediately if she suspects pregnancy.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the tests and herbs mentioned above.
BenicarAn angiotensin-II receptor blocker used as a monotherapy or with other agents to manage hypertension.