irbesartan

(er bah sar' tan)

Avapro

Pregnancy Category D (second and third trimesters)

Pregnancy Category C (first trimester)

Drug classes
Angiotensin II receptor antagonist (ARB)
Antihypertensive

Therapeutic actions
Selectively blocks the binding of angiotensin II to specific tissue receptors found in the
vascular smooth muscle and adrenal gland; this action blocks the vasoconstriction effect
of the renin-angiotensin system as well as the release of aldosterone, leading to decreased
blood pressure.

Indications
• Treatment of hypertension as monotherapy or in combination with other
antihypertensives
• Slowing of the progression of kidney disease in patients with hypertension and
type 2 (non–insulin-dependent) diabetes
• Unlabeled use: CHF

Contraindications and cautions

• Contraindicated with hypersensitivity to irbesartan, pregnancy (use during the
second or third trimester can cause injury or even death to the fetus).
• Use cautiously with hepatic or renal dysfunction, hypovolemia, lactation,
pregnancy.

Available forms
Tablets—75, 150, 300 mg

Dosages
ADULTS
• Diabetic neuropathy: 300 mg/day PO as a single dose.
• Hypertension: 150 mg PO daily as one dose; adjust slowly to determine effective
dose; maximum daily dose—300 mg.
PEDIATRIC PATIENTS
< 6 yr: Not recommended.
6–12 yr: 75 mg/day PO, titrate to a maximum of 150 mg/day.
13–16 yr: 150 mg/day PO; maximum dose 300 mg.
VOLUME- OR SALT-DEPLETED PATIENTS
75 mg/day PO.

Pharmacokinetics
Route Onset Peak
Oral Varies 1–3 hr

Metabolism: Hepatic; T1/2: 11–15 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Feces and urine

Adverse effects
• CNS: Headache, dizziness, syncope, muscle weakness, sleep disturbance
• CV: Hypotension, orthostatic hypotension, flushing
• Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin
• GI: Diarrhea, abdominal pain, nausea, constipation, dry mouth, dental pain
• Respiratory: URI symptoms, cough, sinus disorders
• Other: Cancer in preclinical studies, back pain, fever, gout, fatigue, neutropenia
Interactions
Drug-drug
• Use caution with drugs metabolized by CYP2C9; anticipated effects may be
altered.

Nursing considerations
Assessment
• History: Hypersensitivity to irbesartan, pregnancy, lactation, hepatic or renal
dysfunction, hypovolemia
• Physical: Skin lesions, turgor; T; reflexes, affect; BP; R, respiratory auscultation;
liver and kidney function tests

Interventions
• Administer without regard to meals.
• Ensure that patient is not pregnant before beginning therapy; suggest using barrier
birth control while using irbesartan; fetal injury and deaths have been reported.
• Find an alternative method of feeding the baby if giving drug to a nursing mother.
Depression of the renin-angiotensin system in infants is potentially very
dangerous.
• Alert surgeon and mark patient's chart with notice that irbesartan is being taken.
The blockage of the renin-angiotensin system following surgery can produce
problems. Hypotension may be reversed with volume expansion.
• Monitor patient closely in any situation that may lead to a decrease in blood
pressure secondary to reduction in fluid volume (excessive perspiration,
dehydration, vomiting, diarrhea); excessive hypotension can occur.

Teaching points
• Take this drug without regard to meals. Do not stop taking this drug without
consulting your health care provider.
• Use a barrier method of birth control while on this drug; if you become pregnant
or desire to become pregnant, consult with your physician.
 • These side effects may occur: Dizziness (more likely to occur in any situation
where you may be fluid depleted [extreme heat, exertion, etc.]; avoid driving or
performing hazardous tasks); headache (medications may be available to help);
nausea, vomiting, diarrhea (proper nutrition is important; consult with your
dietitian); symptoms of upper respiratory tract infection, cough (do not self-
medicate; consult with your nurse or physician if this becomes uncomfortable).
• Report fever, chills, dizziness, pregnancy.

Adverse effects in Italic are most common; those in Bold are life-threatening.