Irbesartan

When ATH:
C09CA04

Characteristic.

White or almost white crystalline powder. It is soluble in ethanol and methylene chloride, insoluble in water. Molecular weight 428,5.

Pharmacological action.
Antigipertenzivnoe.

Application.

Arterial hypertension, nephropathy with hypertension and diabetes mellitus type 2 (as part of combination antihypertensive therapy).

Contraindications.

Hypersensitivity, pregnancy, lactation.

Restrictions apply.

Age to 18 years (Safety and efficacy have not been determined).

Pregnancy and breast-feeding.

Contraindicated in pregnancy.

Category actions result in FDA - C (I trimester). (The study of reproduction in animals has revealed adverse effects on the fetus, and adequate and well-controlled studies in pregnant women have not held, However, the potential benefits, associated with drugs in pregnant, may justify its use, in spite of the possible risk.)

Category actions result in FDA - D (II and III trimesters).

At the time of treatment should stop breastfeeding (unknown, whether irbesartan is excreted in breast milk).

Side effects.

From the nervous system and sensory organs: ≥ 1% — headache, dizziness, fatiguability, state of anxiety / irritability.

Cardio-vascular system and blood (hematopoiesis, hemostasis): ≥ 1% of tachycardia.

From the respiratory system: ≥ 1% of upper respiratory tract infection (fever and others.), sinusopatiя, sinusitis, pharyngitis, rhinitis, cough.

From the digestive tract: ≥ 1% of diarrhea, nausea, vomiting, dyspepsia, heartburn.

On the part of the musculoskeletal system: ≥ 1% of musculo-skeletal pain (incl. myalgia, bone pain, Chest).

Allergic reactions: ≥ 1% skin rashes.

Other: ≥ 1% pain in the abdomen, urinary tract infection.

Cooperation.

Diuretics and other antihypertensives. Enhance the effect of thiazide diuretics. Previous treatment with diuretics in high doses can lead to dehydration, and increases the risk of hypotension in the early treatment irbesartan. Irbesartan is compatible with other antihypertensives (beta-blockers, Calcium channel blockers).

Kalievыe additives and kaliysberegayushtie diuretic. It increases the risk of hyperkalemia when combined with potassium-sparing diuretics and potassium supplements.

Lithium: reversible increase in concentration of lithium in blood serum or toxicity was observed while using lithium enzyme inhibitors, konvertiruyushtih angiotensin. With respect to irbesartan, similar effects were hitherto extremely rare, but during simultaneous use of drugs is recommended careful monitoring of lithium levels in serum.

NSAIDs: simultaneous introduction apgiotenzina II antagonists and NSAIDs (such as selective COX-2 inhibitors, acetylsalicylic acid >3 g / day and non-selective NSAIDs) can weaken the effect of hypotonic.

As in the case of ACE inhibitors, concomitant use of angiotensin II antagonists and NSAIDs may increase the risk of renal impairment, including the likelihood of acute renal failure, and lead to an increase in serum potassium, especially in patients with already compromised renal function. With the introduction of this combination should take precautions, especially in elderly patients. Patients must conduct proper hydration and throughout the combination therapy and periodically after its closure to monitor renal function.

Gidroxlorotiazid. The pharmacokinetics of irbesartan is not changed when combined with hydrochlorothiazide.

Irbesartan is metabolized mainly involving CYP2C9 and less glucuronidation. No significant pharmacokinetic or pharmacodynamic interactions when combined administration of irbesartan with warfarin, drug, metabolized via CYP2C9. The effect of such stimulants CYP2C9, as rifampicin on the pharmacokinetics of irbesartan were not evaluated.

Irbesartan does not alter the pharmacokinetics of digoxin.

Overdose.

Symptoms: hypotension, tachycardia or (less often) bradycardia.

Treatment: induction of vomiting and / or gastric lavage, appointment of activated carbon, simptomaticheskaya therapy; hemodialysis nyeeffyektivyen.

Dosing and Administration.

Inside, regardless of the meal, 1 once a day, starting and maintenance dose is 150 mg (if necessary - 300 mg / day). For patients, hemodialysis patients and older 75 years of the initial dose is 75 mg.

Precautions.

To use caution in patients with hyponatremia (diuretic treatment, limiting revenue from salt diet, diarrhea, vomiting), patients, hemodialysis (may develop symptomatic hypotension), and in dehydrated patients. Caution should be exercised in patients with renovascular hypertension, due to bilateral renal artery stenosis or renal artery stenosis sole kidney (an increased risk of severe hypotension and renal insufficiency), aortic or mitral stenosis, obstructive hypertrophic cardiomyopathy, severe heart failure (Stage III-IV of NYHA classification) and coronary heart disease (increased risk of myocardial infarction, angina). Against the background of impaired renal function is recommended to monitor the levels of potassium and creatinine serum. Not recommended for use in patients with primary hyperaldosteronism, in severe renal insufficiency (there is no clinical experience), in patients with a recent kidney transplantation (there is no clinical experience).

Cooperation