irbesartan

CLINICAL USE

Angiotensin-II receptor antagonist:Hypertension Diabetic nephropathy

DOSE IN NORMAL RENAL FUNCTION

75–300 mg daily

PHARMACOKINETICS

Molecular weight :428.5

%Protein binding :96

%Excreted unchanged in urine : <2

Volume of distribution (L/kg) :53–93 litres

half-life – normal/ESRD (hrs) :11–15/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Initial dose 75 mg daily and gradually increase

HD :Not dialysed. Initial dose 75 mg daily and gradually increase

HDF/high flux :Unknown dialysability. Initial dose 75 mg daily and gradually increase

CAV/VVHD :Unknown dialysability. Initial dose 75 mg daily and gradually increase

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: enhanced hypotensive effect

Analgesics: antagonism of hypotensive effect and increased risk of renal impairment with NSAIDs; hyperkalaemia with ketorolac and other NSAIDs

Ciclosporin: increased risk of hyperkalaemia and nephrotoxicity

Diuretics: enhanced hypotensive effect; hyperkalaemia with potassium-sparing diuretics

Epoetin: increased risk of hyperkalaemia; antagonism of hypotensive effect

Lithium: reduced excretion (possibility of enhanced lithium toxicity)

Potassium salts: increased risk of hyperkalaemia

Tacrolimus: increased risk of hyperkalaemia and nephrotoxicity

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Hyperkalaemia and other side effects are more common in patients with impaired renal functionRenal failure has been reported in association with angiotensin-II antagonists in patients with renal artery stenosis, post renal transplant, and in those with congestive heart failureClose monitoring of renal function during therapy is necessary in those with renal insufficiency.

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