Irbesartan

DEA Class; Rx

Common Brand Names; Avapro

• ARBs

Angiotensin II antagonist; used once daily for HTN; also indicated for diabetic nephropathy and proteinuria; longer half-life than losartan or valsartan; additive efficacy with HCTZ; does not inhibit ACE and accumulate bradykinin; less likely to cause cough or angioedema than ACE inhibitors; being studied for use in CHF.

Indicated for the treatment of hypertension.

Hypersensitivity

Do not coadminister with aliskiren in patients with diabetes

• Hyperkalemia (19%)
• Dizziness (10%)
• Upper respiratory tract infection (URTI) (9%)
• Orthostatic hypotension (5%)
• Fatigue (4%)
• Diarrhea (3%)
• Dyspepsia (2%)
• Urticaria; angioedema (involving swelling of the face, lips, pharynx, or tongue); elevated liver function test results; jaundice; hepatitis; hyperkalemia, and thrombocytopenia
• Impaired renal function, including cases of renal failure, has been reported
• Increased creatine phosphokinase (CPK) levels and rhabdomyolysis have been reported in patients receiving angiotensin-receptor blockers (ARBs)
• Anemia
• Hypoglycemia in diabetic patients

Angioedema, volume-depletion, severe congestive heart failure (CHF), hepatic or renal impairment, hypertrophic cardiomyopathy, aortic or mitral valve stenosis, surgery or anesthesia

Discontinue immediately if patient is pregnant; risk of congenital malformations (see Contraindications and Black Box Warnings)

Use with caution in renal artery stenosis; avoid in bilateral renal artery stenosis

Risk of hypotension or hyperkalemia

Dual blockade of the renin-angiotensin system with ARBs, angiotensin-converting enzyme (ACE) inhibitors, or aliskiren is associated with increased risk of hypotension, hyperkalemia, and altered renal function (including acute renal failure) in comparison with monotherapy

Risk of heart failure-related morbidity; concomitant treatment with ACE inhibitors and beta-adrenergic agents is not recommended

Therapy can cause fetal harm when administered to a pregnant woman; use of drugs that act on the renin-angiotensin system during second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death

There are no available data on the presence of irbesartan in human milk, effects on milk production, or breastfed infant