Sanofi-Aventis. Avalide irbesartan-hydrochlorothiazide tablets prescribing information. Bridgewater, NJ; 2016 Feb. These considerations may guide selection of therapy. Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, severe loss of body water and minerals dehydration.
Thiazides appear in human milk. Because of the potential for adverse effects on the nursing infant, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. In Studies I to VI, there was no difference in response for men and women or in patients over or under 65 years of age. Black patients had a larger response to hydrochlorothiazide than non-black patients and a smaller response to irbesartan. The overall response to the combination was similar for black and non-black patients.
Safety and effectiveness in pediatric patients have not been established. Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Perk J, De Backer G, Gohlke H et al. European Guidelines on cardiovascular disease prevention in clinical practice version 2012. The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice constituted by representatives of nine societies and by invited experts.
Patent and Trademark Office and assigns exclusive legal right to the patent holder to protect the proprietary chemical formulation. The patent assigns exclusive legal right to the inventor or patent holder, and may include entities such as the drug brand name, trademark, product dosage form, ingredient formulation, or manufacturing process A patent usually expires 20 years from the date of filing, but can be variable based on many factors, including development of new formulations of the original chemical, and patent infringement litigation. When unstented bilateral renal artery stenosis is present, use is generally avoided due to the elevated risk of deterioration in renal function unless possible benefits outweigh risks.
Hydrochlorothiazide: Hydrochlorothiazide crosses the placental but not the blood-brain barrier and is excreted in breast milk. If adequate BP response not achieved with a single antihypertensive agent, add a second drug with demonstrated benefit; if goal BP still not achieved with optimal dosages of 2 antihypertensive agents, add a third drug. 501 May maximize dosage of the first drug before adding a second drug, or add a second drug before maximizing dosage of the initial drug. Laboratory determinations of serum levels of irbesartan are not widely available, and such determinations have, in any event, no known established role in the management of irbesartan overdose. Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Kossler-Taub K, Littlejohn T, Elliott W et al. Comparative efficacy of two angiotensin II receptor antagonists, irbesartan and losartan, in mild-to-moderate hypertension. Am J Hypertens. Talk to your doctor or about lifestyle changes that might benefit you. Nissen SE. Angiotensin-receptor blockers and cancer: urgent regulatory review needed. Lancet Oncol. Nicorandil: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Cooper WO, Hernandez-Diaz S, Arbogast PG et al. Major congenital malformations after first-trimester exposure to ACE inhibitors. N Engl J Med. American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company. In the unusual case that there is no appropriate alternative to therapy with drugs affecting the renin-angiotensin system for a particular patient, apprise the mother of the potential risk to the fetus. Perform serial ultrasound examinations to assess the intra-amniotic environment. If oligohydramnios is observed, discontinue Irbesartan and Hydrochlorothiazide, unless it is considered lifesaving for the mother. Fetal testing may be appropriate, based on the week of pregnancy. Patients and physicians should be aware, however, that oligohydramnios may not appear until after the fetus has sustained irreversible injury. ACCF, AHA, and the Heart Failure Society of America HFSA recommend that patients with chronic symptomatic heart failure and reduced LVEF NYHA class II or III who are able to tolerate an ACE inhibitor or angiotensin II receptor antagonist be switched to therapy containing an ARNI to further reduce morbidity and mortality.
Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Concomitant use of potassium-sparing diuretics, potassium supplements, or salt substitutes containing potassium may lead to increases in serum potassium. Peterson ED, Gaziano JM, Greenland P. Recommendations for treating hypertension: what are the right goals and purposes? Potential pharmacokinetic interaction decreased irbesartan metabolism with CYP2C9 inhibitors. However, in clinical studies the consequences of concomitant irbesartan on the pharmacodynamics of warfarin were negligible. Concomitant nifedipine or hydrochlorothiazide had no effect on irbesartan pharmacokinetics. Based on in vitro data, no interaction would be expected with drugs whose metabolism is dependent upon cytochrome P450 isoenzymes 1A1, 1A2, 2A6, 2B6, 2D6, 2E1, or 3A4. Tell patients using Irbesartan and Hydrochlorothiazide that getting dehydrated can lower their blood pressure too much and lead to lightheadedness and possible fainting. Dehydration may occur with excessive sweating, diarrhea, or vomiting and with not drinking enough liquids. Volpe M, Morganti A. 2010 Position Paper of the Italian Society of Hypertension SIIA: Angiotensin Receptor Blockers and Risk of Cancer. High Blood Press Cardiovasc Prev. Lifestyle changes such as stress reduction programs, exercise, and dietary changes may increase the effectiveness of this medicine. Talk to your doctor or pharmacist about lifestyle changes that might benefit you. Initial: 75 mg once daily; may be titrated to a maximum of 150 mg once daily NHBPEP, 2004. Management of hypertension alone or in combination with other classes of antihypertensive agents. Eliminated in urine and feces via bile. Deterioration of renal function may occur. 1 26 See Renal Effects under Cautions. Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed. Pitt B, Segal R, Martinez FA et al. Randomised trial of losartan versus captopril in patients over 65 with heart failure Evaluation of Losartan in the Elderly Study, ELITE. Lancet. Two of the 7 placebo-controlled trials identified above and 2 additional placebo-controlled studies examined the antihypertensive effects of Irbesartan and Hydrochlorothiazide in combination. Irbesartan and Hydrochlorothiazide was not mutagenic in standard in vitro tests Ames microbial test and Chinese hamster mammalian-cell forward gene-mutation assay. acarbose
Coadministration of Irbesartan and Hydrochlorothiazide with potassium sparing diuretics, potassium supplements, potassium-containing salt substitutes or other drugs that raise serum potassium levels may result in hyperkalemia, sometimes severe. Monitor serum potassium in such patients. Lewis EJ, Hunsicker LG, Clarke WR et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. In healthy subjects, single oral irbesartan doses of up to 300 mg produced dose-dependent inhibition of the pressor effect of angiotensin II infusions. Inhibition was complete 100% 4 hours following oral doses of 150 mg or 300 mg and partial inhibition was sustained for 24 hours 60% and 40% at 300 mg and 150 mg, respectively. If oliguria or hypotension occurs, direct attention toward support of blood pressure and renal perfusion. Because of the hydrochlorothiazide component, this product is contraindicated in patients with anuria or hypersensitivity to other sulfonamide-derived drugs. The pharmacokinetics of irbesartan following repeated oral administration were not significantly affected in patients with mild to moderate cirrhosis of the liver. No dosage adjustment is necessary in patients with hepatic insufficiency. In the moderate hypertension Study V mean SeDBP between 90 and 110 mmHg the types and incidences of adverse events reported for patients treated with Irbesartan and Hydrochlorothiazide was similar to the adverse event profile in patients on initial irbesartan or HCTZ monotherapy. There were no reported events of syncope in the Irbesartan and Hydrochlorothiazide treatment group and there was one reported event in the HCTZ treatment group. This medication may make you more sensitive to the sun. Avoid prolonged sun exposure, tanning booths, and sunlamps. Use a sunscreen and wear protective clothing when outdoors. How should I take irbesartan? These trials included 3149 patients randomized to fixed doses of irbesartan 37. Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day. It is important to continue taking this medication even if you feel well. Most people with not feel sick. Patient may experience nausea, diarrhea, or loss of strength and energy. Have patient report immediately to prescriber signs of kidney problems urinary retention, blood in urine, change in amount of urine passed, weight gain signs of high potassium abnormal heartbeat, confusion, dizziness, passing out, weak, shortness of breath, numbness or tingling feeling severe dizziness, passing out, angina, tachycardia, or edema HCAHPS. Surgical patients: In patients on chronic angiotensin receptor blocker ARB therapy, intraoperative hypotension may occur with induction and maintenance of general anesthesia; however, discontinuation of therapy prior to surgery is controversial. If continued preoperatively, avoidance of hypotensive agents during surgery is prudent Hillis 2011. bimatoprost store coupons bimatoprost
Drospirenone: Angiotensin II Receptor Blockers may enhance the hyperkalemic effect of Drospirenone. Anon. Drugs for hypertension. Med Lett Drugs Ther. No initial dosage adjustments necessary. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Sulfonamide or sulfonamide derivative drugs, such as hydrochlorothiazide, can cause an idiosyncratic reaction, resulting in transient myopia and acute angle-closure glaucoma. Cases of acute angle-closure glaucoma have been reported with hydrochlorothiazide. Symptoms include acute onset of decreased visual acuity or ocular pain and typically occur within hours to weeks of drug initiation. Untreated acute angle-closure glaucoma can lead to permanent vision loss. The primary treatment is to discontinue drug intake as rapidly as possible. Prompt medical or surgical treatments may need to be considered if the intraocular pressure remains uncontrolled. Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy. Hydrochlorothiazide: Hydrochlorothiazide is not metabolized but is eliminated rapidly by the kidney. At least 61% of the oral dose is eliminated unchanged within 24 hours. Patients with stage 2 moderate or severe hypertension are at relatively high risk for cardiovascular events such as strokes, heart attacks, and heart failure kidney failure, and vision problems, so prompt treatment is clinically relevant. The decision to use a combination as initial therapy should be individualized and may be shaped by considerations such as the baseline blood pressure, the target goal, and the incremental likelihood of achieving goal with a combination compared with monotherapy. No substantial differences in safety or efficacy of irbesartan monotherapy or fixed-combination containing irbesartan and hydrochlorothiazide relative to younger adults, but increased sensitivity cannot be ruled out. Tell your doctor all medications and supplements you use. Irbesartan is not recommended for use during pregnancy. If used during the second and third trimesters, irbesartan can cause and fetal death. It is unknown if irbesartan passes into breast milk. Because of the potential for unwanted effects in a nursing infant, breastfeeding while using irbesartan is not recommended. The choice of Irbesartan and Hydrochlorothiazide as initial therapy for hypertension should be based on an assessment of potential benefits and risks. American Diabetes Association. Standards of medical care in diabetes--2014. Diabetes Care. Ellis ML, Patterson JH. A new class of antihypertensive therapy: angiotensin II receptor antagonists. Pharmacotherapy. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?
Refer to storage information printed on the package. Table 2 presents results for demographic subgroups. Kaplan NM. Choice of initial therapy for hypertension. JAMA. Category D. a b 26 See Boxed Warning. Food and Drug Administration. FDA drug safety communication: No increase in risk of cancer with certain blood pressure drugs-angiotensin receptor blockers ARBs. Rockville, MD; 2011 Jun 2. Available from FDA website. RxList is part of the WebMD Health Network. The opinions expressed in the WebMD User Reviews are solely those of the User, who may or may not have medical or scientific training, and do not represent the opinions of WebMD. These member reviews have not been reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other purpose except for compliance with our Terms and Conditions. Documentation of allergenic cross-reactivity for angiotensin receptor blockers is limited. Angioedema: Angioedema has been reported rarely with some angiotensin II receptor antagonists ARBs and may occur at any time during treatment especially following first dose. It may involve the head and neck potentially compromising airway or the intestine presenting with abdominal pain. Patients with idiopathic or hereditary angioedema or previous angioedema associated with ACE-inhibitor therapy may be at an increased risk. Prolonged frequent monitoring may be required, especially if tongue, glottis, or larynx are involved, as they are associated with airway obstruction. Patients with a history of airway surgery may have a higher risk of airway obstruction. Discontinue therapy immediately if angioedema occurs. Aggressive early management is critical. Intramuscular IM administration of epinephrine may be necessary. Do not readminister to patients who have had angioedema with ARBs. In separate studies of patients receiving maintenance doses of warfarin, hydrochlorothiazide, or digoxin, irbesartan administration for 7 days had no effect on the pharmacodynamics of warfarin prothrombin time or pharmacokinetics of digoxin. The pharmacokinetics of irbesartan were not affected by coadministration of nifedipine or hydrochlorothiazide. Carvedilol: CYP2C9 Inhibitors Moderate may increase the serum concentration of Carvedilol. Specifically, concentrations of the S-carvedilol enantiomer may be increased. Irbesartan: Irbesartan is metabolized via glucuronide conjugation and oxidation. Following oral or intravenous administration of 14C-labeled irbesartan, more than 80% of the circulating plasma radioactivity is attributable to unchanged irbesartan. The primary circulating metabolite is the inactive irbesartan glucuronide conjugate approximately 6%. Carefully monitor BP during initial titration or subsequent upward adjustment in dosage. asel.info fenofibrate
In the unusual case that there is no appropriate alternative to therapy with drugs affecting the renin-angiotensin system for a particular patient, apprise the mother of the potential risk to the fetus. Perform serial ultrasound examinations to assess the intra-amniotic environment. If oligohydramnios is observed, discontinue irbesartan, unless it is considered life saving for the mother. Fetal testing may be appropriate, based on the week of pregnancy. Patients and physicians should be aware, however, that oligohydramnios may not appear until after the fetus has sustained irreversible injury. Does not share the ACE inhibitor common adverse effect of dry cough. Irbesartan and Hydrochlorothiazide may be used in patients whose blood pressure is not adequately controlled on monotherapy. Irbesartan is an angiotensin II receptor antagonist. Irbesartan keeps blood vessels from narrowing, which lowers blood pressure and improves blood flow. It is unknown if this product passes into milk. Consult your doctor before breast-feeding. The curve of each treatment group in each study was estimated by logistic regression modeling from all available data of that treatment group. The estimated likelihood at the right tail of each curve is less reliable due to small numbers of subjects with high baseline blood pressures. neurontin in generic pharmacy
American Stroke Association. Stroke. Radioactivity was present in the rat and rabbit fetus during late gestation and in rat milk following oral doses of radiolabeled irbesartan. Hydrochlorothiazide: Thiazide diuretics have been reported to cause exacerbation or activation of systemic lupus erythematosus. What should I discuss with my healthcare provider before taking hydrochlorothiazide and irbesartan Avalide? The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist. JATOS Study Group. Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients JATOS. Hypertens Res. An American Heart Association Scientific Statement from the Council on Clinical Cardiology Subcommittee on Exercise, Cardiac rehabilitation, and Prevention. Circulation. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs. Canagliflozin: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Canagliflozin may enhance the hypotensive effect of Angiotensin II Receptor Blockers. Irbesartan and Hydrochlorothiazide combination than on placebo, regardless of drug relationship. The recommended initial dose of irbesartan tablet USP is 150 mg once daily. Patients requiring further reduction in blood pressure should be titrated to 300 mg once daily. Surgical treatment may be recommended for people with nerve damage from injury or nerve compression. Mobility aids, such as a cane, walker, or wheelchair, may be helpful. For pain, your doctor may prescribe pain medication. Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Chronic kidney disease CKD and hypertension: Regardless of race or diabetes status, the use of an ACE inhibitor ACEI or angiotensin receptor blocker ARB as initial therapy is recommended to improve kidney outcomes. In the general nonblack population without CKD including those with diabetes, initial antihypertensive treatment should consist of a thiazide-type diuretic, calcium channel blocker, ACEI, or ARB. In the general black population without CKD including those with diabetes, initial antihypertensive treatment should consist of a thiazide-type diuretic or a calcium channel blocker instead of an ACEI or ARB. If you are being treated for high blood pressure, keep using this medication even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life. Lowering blood pressure reduces the risk of fatal and nonfatal events, primarily strokes and myocardial infarctions. James PA, Oparil S, Carter BL et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee JNC 8. JAMA. Older adults may be more sensitive to the side effects of this drug, especially and change in the amount of urine problems. Although irbesartan may be used to prevent kidney problems or treat people who have kidney problems, it may also rarely cause serious kidney problems or make them worse. Your doctor will check your kidney function while you are taking irbesartan. Tell your doctor right away if you have any signs of kidney problems such as a change in the amount of urine. Our Irbesartan Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication. Williams CL, Hayman LL, Daniels SR et al. Cardiovascular health in childhood: a statement for health professional from the Committee on Atherosclerosis, Hypertension, and Obesity in the Young AHOY of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. procyclidine generic appearance
Wright JT, Dunn JK, Cutler JA et al. Outcomes in hypertensive black and nonblack patients treated with chlorthalidone, amlodipine, and lisinopril. JAMA. Such volume depletion should be corrected prior to administration of antihypertensive therapy. Neaton JD, Kuller LH. Diuretics are color blind. JAMA. Store at room temperature away from moisture and heat. What happens if I miss a dose? Of 4925 subjects receiving irbesartan tablets in controlled clinical studies of hypertension, 911 18. The terminal elimination half-life of irbesartan averages 11 to 15 hours. Heparin Low Molecular Weight: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Eplerenone: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. In elderly subjects age 65 to 80 years irbesartan elimination half-life was not significantly altered, but AUC and C max values were about 20% to 50% greater than those of young subjects age 18 to 40 years. No dosage adjustment is necessary in the elderly. Safety and efficacy of the fixed-combination preparation containing irbesartan and hydrochlorothiazide not established. Check the labels on all your medicines such as -and-cold products, because they may contain ingredients that could increase the side effects of ginseng. Although may be used to prevent problems or treat people who have problems, it may also rarely cause serious kidney problems or make them worse. Your doctor will check your kidney function while you are taking irbesartan. Tell your doctor right away if you have any signs of kidney problems such as a change in the amount of urine. Siragy HM. A current evaluation of the safety of angiotensin receptor blockers and direct renin inhibitors. Vasc Health Risk Manag. cheap indocin purchase now visa
In most patients no benefit has been associated with using two RAS inhibitors concomitantly. In general, avoid combined use of RAS inhibitors. Use of irbesartan in fixed combination with hydrochlorothiazide is not recommended in patients with severe renal impairment. P450 isoenzymes 1A1, 1A2, 2A6, 2B6, 2D6, 2E1, or 3A4. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall. Morgensen CE, Neldman S, Tikkanen I et al. Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria CALM study. BMJ. Thiazides may decrease urinary calcium excretion. Thiazides may cause intermittent and slight elevation of serum calcium in the absence of known disorders of calcium metabolism. Marked hypercalcemia may be evidence of hidden hyperparathyroidism. Thiazides should be discontinued before carrying out tests for parathyroid function. Angiotensin II receptor antagonists may be used as an alternative for those patients in whom an ACE inhibitor or ARNI is inappropriate. Irbesartan is an angiotensin receptor blocker ARB and works by relaxing vessels so that can flow more easily. Hydrochlorothiazide is a "water pill" that causes you to make more urine, which helps your body get rid of extra salt and water. In healthy black patients, AUC values were approximately 25% greater than white patients. Yohimbine: May diminish the antihypertensive effect of Antihypertensive Agents. Untreated chronic maternal hypertension is also associated with adverse events in the fetus, infant, and mother. The use of angiotensin II receptor blockers is not recommended to treat chronic uncomplicated hypertension in pregnant women and should generally be avoided in women of reproductive potential ACOG, 2013. In patients who are elderly, volume-depleted including those on diuretic therapy or with compromised renal function, coadministration of NSAIDs, including selective COX-2 inhibitors, with angiotensin II receptor antagonists, including irbesartan, may result in deterioration of renal function, including possible acute renal failure. These effects are usually reversible. Monitor renal function periodically in patients receiving irbesartan and NSAID therapy. In rare cases, irbesartan can cause a condition that results in the breakdown of skeletal muscle tissue, leading to kidney failure. Call your doctor right away if you have unexplained muscle pain, tenderness, or weakness especially if you also have fever, unusual tiredness, and dark colored urine. Adolescents off-label use: Initial: 150 mg once daily; may be titrated to a maximum dose of 300 mg once daily NHBPEP, 2004.
No significant drug-drug pharmacokinetic or pharmacodynamic interactions have been found in interaction studies with hydrochlorothiazide, digoxin, warfarin, and nifedipine. Before having surgery, tell your doctor or dentist about all the products you use including prescription drugs, nonprescription drugs, and herbal products. Angiotensin II receptor antagonists have been used in the management of heart failure. Irbesartan and Hydrochlorothiazide than in the group treated with irbesartan. Importance of informing patients of other important precautionary information. 1 26 See Cautions. Consult your doctor before using this product. does target canada sell proventil
Irbesartan and Hydrochlorothiazide may also be used as initial therapy in patients who are likely to need multiple drugs to achieve their blood pressure goals. Black hypertensive patients generally tend to respond better to monotherapy with calcium-channel blockers or thiazide diuretics than to angiotensin II receptor antagonists. 500 501 504 However, diminished response to an angiotensin II receptor antagonist is largely eliminated when administered concomitantly with a calcium-channel blocker or thiazide diuretic. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The adverse reaction information from clinical trials does, however, provide a basis for identifying the adverse events that appear to be related to drug use and for approximating rates. Impaired renal function, including cases of renal failure, has been reported. Lewis EJ. Angiotensin-receptor blockers, type 2 diabetes, and renoprotection. N Engl J Med. Brimonidine Topical: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Pasternak B, Svanström H, Callréus T et al. Use of angiotensin receptor blockers and the risk of cancer. Circulation. These effects are usually reversible. Hypertension: Management of hypertension alone or in combination with other antihypertensives. Bristol-Myers Squibb Company. Princeton, NJ: Personal communication. eulexin
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When pregnancy is detected, discontinue irbesartan tablets as soon as possible. Potassium-Sparing Diuretics: Angiotensin II Receptor Blockers may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. ACE Inhibitors. Angiotensin II Receptor Blockers may increase the serum concentration of ACE Inhibitors. Management: In US labeling, use of telmisartan and ramipril is not recommended. It is not clear if any other combination of an ACE inhibitor and an ARB would be any safer. Consider alternatives to the combination when possible.
It is not known whether irbesartan is excreted in human milk, but irbesartan or some metabolite of irbesartan is secreted at low concentration in the milk of lactating rats. Because of the potential for adverse effects on the nursing infant, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother. National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Irbesartan is metabolized via glucuronide conjugation and oxidation. Following oral or intravenous administration of 14C-labeled irbesartan, more than 80% of the circulating plasma radioactivity is attributable to unchanged irbesartan. The primary circulating metabolite is the inactive irbesartan glucuronide conjugate approximately 6%.
Irbesartan is a specific competitive antagonist of AT 1 receptors with a much greater affinity more than 8500-fold for the AT 1 receptor than for the AT 2 receptor, and no agonist activity. Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. The antihypertensive effect of angiotensin II receptor antagonists, including irbesartan, may be attenuated by NSAIDs including selective COX-2 inhibitors. Irbesartan does not inhibit ACE or renin or affect other hormone receptors or ion channels known to be involved in the cardiovascular regulation of blood pressure and sodium homeostasis. Because irbesartan does not inhibit ACE, it does not affect the response to bradykinin; whether this has clinical relevance is not known.
Irbesartan and its metabolites are excreted by both biliary and renal routes. Following either oral or intravenous administration of 14C-labeled irbesartan, about 20% of radioactivity is recovered in the urine and the remainder in the feces, as irbesartan or irbesartan glucuronide. CYP2C9 Substrates: CYP2C9 Inhibitors Moderate may decrease the metabolism of CYP2C9 Substrates. Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. USP. Inactive ingredients include: colloidal silicon dioxide, croscarmellose sodium, ferric oxide red, ferric oxide yellow, lactose, magnesium stearate, microcrystalline cellulose and povidone.