Hydrochlorothiazide Irbesartan

Hydrochlorothiazide Irbesartan Brand Name– Avalide

What is Hydrochlorothiazide Irbesartan

Hydrochlorothiazide irbesartan are used together in a once daily oral preparation to manage hypertension.

Hydrochlorothiazide is a thiazide diuretic. Irbesartan is a specific and selective angiotensin II antagonist.

Irbesartan has a longer half-life than losartan and valsartan; however, all three agents can be effectively dosed once daily for hypertension.

Compared to losartan, irbesartan does not require dosage adjustment for hepatic insufficiency, is not metabolized to an active metabolite, and lacks uricosuric effects.

Because AT₁ receptors are nearly saturated at the starting doses for most angiotensin II antagonists, the antihypertensive dose-response curve for these drugs is nonlinear, with proportionally small decreases in blood pressure attained with increased dosage.

Greater antihypertensive efficacy is generally achieved by adding a small dose of hydrochlorothiazide to the angiotensin II antagonist.

Irbesartan tends to reverse the potassium loss associated with hydrochlorothiazide. Because irbesartan does not inhibit angiotensin converting enzyme (ACE), it does not result in bradykinin accumulation which is theorized to cause the cough and angioedema associated with ACE inhibitors.

However, angioedema has been rarely associated with irbesartan or other angiotensin II antagonists.

Avalide was approved by the FDA in September 1997.

Indications

• hypertension

For the treatment of hypertension in patients who do not respond to monotherapy and/or as initial therapy in patients likely to need multiple drugs to achieve blood pressure goals

Side Effects

1. abdominal pain
2. agranulocytosis
3. alopecia
4. anaphylactic shock
5. angioedema
6. aplastic anemia
7. azotemia
8. blurred vision
9. chest pain (unspecified)
10. conjunctivitis
11. cough
12. dizziness
13. dyspepsia
14. elevated hepatic enzymes
15. exfoliative dermatitis
16. fatigue
17. fever
18. gout
19. hemolytic anemia
20. hepatitis
21. hyperbilirubinemia
22. hypercalcemia
23. hypercholesterolemia
24. hyperglycemia
25. hyperkalemia
26. hypertriglyceridemia
27. hyperuricemia
28. hypokalemia
29. hypomagnesemia
30. hypotension
31. hypovolemia
32. impotence (erectile dysfunction)
33. jaundice
34. leukopenia
35. muscle cramps
36. musculoskeletal pain
37. myopia
38. nausea
39. nephrolithiasis
40. ocular hypertension
41. orthostatic hypotension
42. pancreatitis
43. photosensitivity
44. rhabdomyolysis
45. serious hypersensitivity reactions or anaphylaxis
46. sialadenitis
47. Stevens-Johnson syndrome
48. syncope
49. teratogenesis
50. thrombocytopenia
51. tinnitus
52. toxic epidermal necrolysis
53. urticaria
54. vomiting
55. xanthopsia

Monitoring Parameters

• blood glucose
• blood pressure
• LFTs
• serum bilirubin (total and direct)
• serum creatinine/BUN
• serum electrolytes
• serum uric acid

Contraindications

• ACE-inhibitor induced angioedema
• angioedema
• anuria
• asthma
• breast-feeding
• children
• diabetes mellitus
• electrolyte imbalance
• geriatric
• gout
• heart failure
• hepatic disease
• hypercalcemia
• hyperglycemia
• hyperkalemia
• hyperuricemia
• hypokalemia
• hypomagnesemia
• hyponatremia
• hypotension
• hypovolemia
• orthostatic hypotension
• pancreatitis
• penicillin hypersensitivity
• pregnancy
• renal artery stenosis
• renal disease
• renal failure
• renal impairment
• sulfonamide hypersensitivity
• sunlight (UV) exposure
• surgery
• sympathectomy
• syncope
• systemic lupus erythematosus (SLE)
• thiazide diuretic hypersensitivity

Interactions

• Acarbose
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
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• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
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• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Dichloralphenazone; Isometheptene
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetaminophen; Hydrocodone
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• Hydrocodone
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• Hydrocodone; Potassium Guaiacolsulfonate
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• Hyoscyamine
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