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.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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