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Irbesartan: Indications, Dosing, Side Effects and Interactions
Irbesartan clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Irbesartan: Indications, Dosing, Side Effects and Interactions
Irbesartan clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Hypertension**
- **Adult** (By Mouth): 75 years and over Initially 75-150 mg once daily, increased if necessary to 300 mg once daily.
**Hypertension in patients receiving haemodialysis**
- **Adult** (By Mouth): Initially 75-150 mg once daily, increased if necessary to 300 mg once daily.
**Renal disease in hypertensive type 2 diabetes mellitus**
- **Adult** (By Mouth): 75 years and over Initially 75-150 mg once daily, increased if tolerated to 300 mg once daily.
**Renal disease in hypertensive type 2 diabetes mellitus in patients receiving haemodialysis**
- **Adult** (By Mouth): Initially 75-150 mg once daily, increased if tolerated to 300 mg once daily.
Cautions
II receptor antagonists Aortic or mitral valve stenosis; elderly (lower initial doses may be appropriate); hypertrophic cardiomyopathy; patients of black African or African-Caribbean origin; patients with a history of angioedema; patients with primary aldosteronism (may not benefit from an angiotensin-II receptor antagonist); renal artery stenosis Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: with hyperkalaemia with persistent postural hypotension i.e. recurrent drop in systolic blood pressure 20 mmHg (risk of syncope and falls)
Contraindications
II receptor antagonists The combination of an angiotensin-II receptor antagonist with aliskiren is contra-indicated in patients with an eGFR less than 60 mL/minute/1.73 m 2 ; the combination of an angiotensin-II receptor antagonist with aliskiren is contra-indicated in patients with diabetes mellitus
Side effects
II receptor antagonists Common or very common Abdominal pain; asthenia; back pain; cough; diarrhoea; dizziness; headache; hyperkalaemia; hypotension; nausea; postural hypotension (more common in patients with intravascular volume depletion, e.g. those taking high-dose diuretics); renal impairment; vertigo; vomiting Uncommon Angioedema; myalgia; skin reactions; thrombocytopenia Rare or very rare Arthralgia; hepatic function abnormal Side-effects For irbesartan Common or very common Musculoskeletal pain Uncommon Chest pain; dyspepsia; flushing; hepatic disorders; sexual dysfunction; tachycardia Frequency not known Hypersensitivity vasculitis; muscle cramps; taste altered; tinnitus
Interactions
**Severe interactions:**
- No significant pharmacokinetic or pharmacodynamic interactions were observed when irbesartan was coadministered with warfarin, a medicinal product metabolised by CYP2C9.
**Other interactions (13):**
- Diuretics and other antihypertensive agents: other antihypertensive agents may increase the hypotensive effects of irbesartan; however Aprovel has been safely administered with other...
- Prior treatment with high dose diuretics may result in volume depletion and a risk of hypotension when initiating therapy with Aprovel (see section 4.4).
- Aliskiren-containing products and ACE-inhibitors: clinical trial data has shown that dual blockade of the renin-angiotensin-aldosterone system (RAAS) through the combined use of ACE-inhibitors,...
- Potassium supplements and potassium-sparing diuretics: based on experience with the use of other medicinal products that affect the renin-angiotensin system, concomitant use of potassium-sparing...
- Similar effects have been very rarely reported with irbesartan so far.
- If the combination proves necessary, careful monitoring of serum lithium levels is recommended.
Pregnancy
Important safety information For all angiotensin II receptor antagonists MHRA/CHM advice: ACE inhibitors and angiotensin II receptor antagonists: not for use in pregnancy (December 2014) See Conception and contraception and Pregnancy . MHRA/CHM advice: ACE inhibitors and angiotensin II receptor antagonists: recommendations on how to use for breastfeeding (December 2014) See Breast feeding .
Breast feeding
II receptor antagonists Information on the use of angiotensin-II receptor antagonists in breast-feeding is limited. They are not recommended in breast-feeding. Alternative treatment options, with better established safety profile during breast-feeding, are preferable M (recommendation also supported by specialist sources).
Hepatic impairment
II receptor antagonists In general, manufacturers advise caution in mild to moderate impairment (limited information available); avoid in severe impairment (no information available).
Renal impairment
II receptor antagonists Dose adjustments In general, manufacturers advise start with low dose and adjust according to response.
Medicinal forms
Suspension
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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