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Irbesartan

Class
Antihypertensives
Subclass
Angiotensin receptor blockers
Generic name
Irbesartan
Brand names
Avapro®
Common formulations
Film-coated tablet
Dosage and administration
Adults patients
Treatment
Diabetic nephropathy in patients with diabetes mellitus type 2
•
300 mg PO daily
Reduce starting dose to 75 mg daily in patients with depletion of intravascular volume or salt (e.g., patients treated vigorously with diuretics or on hemodialysis). Target BP of 130/80 mmHg in diabetic patients.
Hypertension
•
Maintenance: 150 mg PO daily
•
Maximum: 300 mg per day
Reduce starting dose to 75 mg daily in patients with depletion of intravascular volume or salt (e.g., patients treated vigorously with diuretics or on hemodialysis).
LVH • Off-label
•
150 mg PO daily
Proteinuria in patients with CKD • Off-label
•
150-300 mg PO daily
Secondary prevention
Secondary prevention of AF • Recurrent AF • Off-label
•
150-300 mg PO daily
As adjunctive treatment.
Other off-label uses
•
Adjunctive treatment for acute coronary syndromes
Indications for use
Labeled indications
Adults
•
Treatment of diabetic nephropathy in patients with diabetes mellitus type 2
•
Treatment of hypertension
Off-label indications
Adults
•
Treatment of LVH
•
Treatment of proteinuria in patients with CKD
•
Adjunctive treatment for acute coronary syndromes
•
Secondary prevention of AF (recurrent AF)
Safety risks
Boxed warnings
Fetal toxicity
Contraindications
Hypersensitivity to irbesartan or its components
Concomitant use of aliskiren in patients with diabetes
Warnings and precautions
Hypotension
•
Use extreme caution in patients with depletion of intravascular volume, such as those on dialysis or receiving high doses of diuretics. Reduce dosage to 75mg PO q24h.
Increased serum creatinine, increased BUN
•
Use caution in patients with unilateral or bilateral renal artery stenosis.
Renal failure
•
Use caution in susceptible patients, such as with renal function dependent on the activity of the RAAS.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Monitor renal function. Monitor for hyperkalemia.
Renal replacement therapy
Continuous renal replacement
•
Start at a dose of 75mg. Monitor renal function. Titrate with caution. Monitor for hyperkalemia.
Intermittent hemodialysis
•
Start at a dose of 75mg. Monitor renal function. Titrate with caution. Monitor for hyperkalemia.
Peritoneal dialysis
•
Start at a dose of 75mg. Monitor renal function. Titrate with caution. Monitor for hyperkalemia.
Hepatic impairment
Child-Pugh A (mild)
•
Use acceptable. No dose adjustment required.
Child-Pugh B (moderate)
•
Use acceptable. No dose adjustment required.
Child-Pugh C (severe)
•
Use acceptable. No dose adjustment required.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: D
•
Avoid use. Evidence of fetal harm in humans. If a pregnancy is detected, this drug should be discontinued as soon as possible.
•
Adequate methods of contraception should be encouraged.
Breastfeeding
Do not use during breastfeeding.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Common 1-10%
•
Cardiac arrest, conjunctivitis, depression, ecchymosis, erectile dysfunction, exacerbation of arrhythmia, gout, heart failure, hypertension, hypertensive crisis, influenza virus infection, myocardial infarction, orthostatic hypotension, pharyngitis, abdominal pain, angina pectoris, anxiety, chills, constipation, cough, ↓ libido, diarrhea, dizziness, dyspepsia, dyspnea, fatigue, fever, flatulence, headache, heartburn, ↑ libido, itching, muscle cramps, musculoskeletal pain, nausea, nosebleed, paresthesia, skin flushing, skin rash, somnolence, visual disturbances, vomiting, weakness, rhinitis, sinus tachycardia, skin erythema, tremor, wheezing
Uncommon < 1%
•
↓ blood neutrophil count, hypotension
Unknown frequency
•
Anaphylaxis, anemia, angioedema, ↓ blood glucose, ↓ platelet count, hepatitis, ↑ BUN, ↑ liver enzymes, ↑ serum potassium, jaundice, renal failure, low urine output, syncope, tinnitus, vertigo, rhabdomyolysis, stroke, teratogenesis, urticaria
Interactions
Drug(s)
Check Interactions
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