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Pharmacologic class: Angiotensin II receptor antagonist
Therapeutic class: Antihypertensive
Pregnancy risk category C (first trimester), D (second and third trimesters)
Blocks aldosterone-stimulating and vasoconstrictive effects of angiotensin II at receptor sites in vascular smooth muscles and adrenal glands, decreasing vascular resistance
Tablets: 400 mg, 600 mg
Indications and dosages
Adults: 600 mg P.O. once daily or in divided doses b.i.d. Total daily dosage range is 400 to 800 mg.
• Hypersensitivity to drug or its components
• Pregnancy or breastfeeding
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).
• 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.
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
Metabolic: gout, hyperkalemia
Musculoskeletal: joint pain, back pain, muscle weakness
Respiratory: upper respiratory tract infection, cough, bronchitis
Other: dental pain, fever, facial edema
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
• 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.
• 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.
Pharmacologic: angiotensin ii receptor antagonists
Time/action profile (antihypertensive effect with chronic dosing)
|PO||within 1–2 hr||2–3 wksr||24 hr|
Adverse Reactions/Side Effects
Central nervous system
Ear, Eye, Nose, Throat
Fluid and Electrolyte
- abdominal pain
- impaired renal function
- angioedema (life-threatening)
Drug-Drug interactionAdditive hypotension with other antihypertensives.Excessive hypotension may occur with concurrent use of diuretics.↑ risk of hyperkalemia with concurrent use of potassium supplements,potassium-containing salt substitutes, or potassium-sparing diuretics.↑ 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/minNSAIDs and selective COX-2 inhibitors may blunt the antihypertensive effect and ↑ the risk of renal dysfunction.
Renal ImpairmentOral (Adults) CCr <60 mL/min—Do not exceed 600 mg/day.
Availability (generic available)
- Assess BP (lying, sitting, standing) and pulse frequently during initial dosage adjustment and periodically throughout 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 increase in BUN and serum creatinine.
- May cause hyperkalemia.
- May cause elevated AST, ALT, and alkaline phosphatase.
- May cause slight decrease in hemoglobin, neutropenia, or thrombocytopenia.
Potential Nursing DiagnosesRisk for injury (Adverse Reactions)
Noncompliance (Patient/Family Teaching)
- Volume depletion should be corrected, if possible, before initiation of therapy.
- Oral: May be administered without regard to meals.
- 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.
- 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.
- 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 consult health care professional before taking any new medications, especially cough, cold, or allergy remedies.
- 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 suspected or planned, or if breastfeeding. If pregnancy is detected, discontinue medication as soon as possible. Avoid breastfeeding.
- Emphasize the importance of follow-up exams to evaluate effectiveness of medication.
- Decrease in BP without appearance of excessive side effects.