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
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Codeine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Guaifenesin; Phenylephrine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Pentazocine
  • Acetaminophen; Pseudoephedrine
  • Acetaminophen; Tramadol
  • Acetazolamide
  • Acetohexamide
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  • Acrivastine; Pseudoephedrine
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  • Aliskiren; Hydrochlorothiazide, HCTZ
  • Aliskiren; Valsartan
  • Allopurinol
  • Alogliptin
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  • Aspirin, ASA; Oxycodone
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  • Fenoprofen
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  • Fosinopril
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  • Glyburide
  • Glyburide; Metformin
  • Glycopyrrolate
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  • Granisetron
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  • Hydrocodone
  • Hydrocodone; Ibuprofen
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