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Irbesartan: Drug information

Irbesartan: Drug information
(For additional information see "Irbesartan: Patient drug information" and see "Irbesartan: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
ALERT: US Boxed Warning
Fetal toxicity:

When pregnancy is detected, discontinue irbesartan as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and even death to the developing fetus.

Brand Names: US
  • Avapro
Brand Names: Canada
  • AG-Irbesartan [DSC];
  • APO-Irbesartan [DSC];
  • Auro-Irbesartan [DSC];
  • Avapro;
  • BIO-Irbesartan [DSC];
  • JAMP-Irbesartan [DSC];
  • M-Irbesartan;
  • MINT-Irbesartan;
  • PMS-Irbesartan;
  • Priva-Irbesartan [DSC];
  • RIVA-Irbesartan;
  • SANDOZ Irbesartan;
  • TARO-Irbesartan;
  • TEVA-Irbesartan
Pharmacologic Category
  • Angiotensin II Receptor Blocker;
  • Antihypertensive
Dosing: Adult
Acute coronary syndrome

Acute coronary syndrome:

Note: Alternative in patients who cannot tolerate an angiotensin-converting enzyme (ACE) inhibitor (eg, due to cough) (Ref). In patients with prior ACE inhibitor-associated angioedema (ie, without urticaria or other signs of hypersensitivity), an angiotensin II receptor blocker (ARB) may still be an alternative. ARBs do not appear to elevate the risk of angioedema (Ref); however, patients must be educated that angioedema due to an ACE inhibitor can sometimes reoccur within months following discontinuation (Ref); referral to an allergist may be appropriate.

Non–ST-elevation acute coronary syndrome (alternative agent) (off-label use):

Note: Initiate in stable patients prior to hospital discharge as a component of an appropriate medical regimen, which may include antiplatelet agent(s), a beta-blocker, and a statin. Continue indefinitely for patients with concurrent diabetes, left ventricular ejection fraction ≤40%, hypertension, or stable chronic kidney disease (Ref). Dosing is based on general dosing range in the manufacturer's labeling.

Oral: Initial: 150 mg once daily; increase dose as needed based on response and tolerability up to a maximum dose of 300 mg once daily.

ST-elevation myocardial infarction (alternative agent) (off-label use):

Note: In hemodynamically stable patients with large anterior ST-elevation myocardial infarction, consider starting within 24 hours of presentation as a component of an appropriate medical regimen, which may include antiplatelet agent(s), a beta-blocker, and a statin. Continue therapy indefinitely (Ref).

Oral: Initial: 150 mg once daily; increase dose as needed based on response and tolerability up to a maximum dose of 300 mg once daily.

Hypertension, chronic

Hypertension, chronic:

Note: For patients who warrant combination therapy (BP >20/10 mm Hg above goal or suboptimal response to initial monotherapy), may use with another appropriate agent (eg, long-acting dihydropyridine calcium channel blocker or thiazide diuretic) (Ref).

Oral: 150 mg once daily; evaluate response after ~2 to 4 weeks and titrate dose (eg, increase the daily dose by doubling) as needed up to 300 mg once daily; if additional blood pressure control is needed, consider combination therapy. Patients with severe asymptomatic hypertension and no signs of acute end organ damage should be evaluated for medication titration within 1 week (Ref).

Proteinuric chronic kidney disease, diabetic or nondiabetic

Proteinuric chronic kidney disease, diabetic (labeled use) or nondiabetic (off-label use):

Oral: Initial: 150 mg once daily; titrate gradually (eg, by doubling the dose every 2 to 4 weeks) to the maximally tolerated dose, not to exceed 300 mg/day. If proteinuria target is not met despite optimized dosage, consider additional therapies (eg, sodium-glucose cotransporter-2 inhibitor) (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Kidney impairment prior to treatment initiation:

Altered kidney function: No dosage adjustment necessary for any degree of kidney dysfunction (Ref).

Hemodialysis, intermittent (thrice weekly): Not significantly dialyzed: No supplemental dose or dosage adjustment necessary (Ref).

Peritoneal dialysis: Unlikely to be significantly dialyzed (highly protein bound): No dosage adjustment necessary (Ref).

CRRT: No dosage adjustment necessary (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (Ref).

Alterations in kidney function during treatment:

Small, transient increases in serum creatinine are likely to occur within 4 weeks following initiation of therapy or an increase in dose. If serum creatinine increases by >30%, review for possible etiologies (eg, acute kidney injury, volume depletion, concomitant medications, renal artery stenosis) before determining if dose reduction or discontinuation of irbesartan therapy should be considered (Ref).

Dosing: Hepatic Impairment: Adult

No dosage adjustment necessary. Should be used with caution in patients with ascites due to cirrhosis (Ref).

Dosing: Adjustment for Toxicity: Adult

Hyperkalemia: Assess for alternative or contributing factors (eg, diet, concomitant medications) of increased potassium before determining if dose reduction or discontinuation of irbesartan therapy should be considered (Ref).

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Irbesartan: Pediatric drug information")

Hypertension

Hypertension: Limited data available (Ref): Note: Use a lower starting dose of 50% of the recommended initial dose in volume- and salt-depleted patients.

Children ≥6 years: Oral: Initial: 75 mg once daily; may be titrated to a maximum dose of 150 mg once daily

Adolescents: Oral: Initial: 150 mg once daily; may be titrated to a maximum dose of 300 mg once daily

Proteinuria reduction in children with chronic kidney disease

Proteinuria reduction in children with chronic kidney disease: Limited data available: Children ≥4 years and Adolescents: Oral: Studies utilized a fixed dosage based on weight categories (see the following); initial doses were approximately 2 mg/kg once daily; doses were increased after 3 to 5 weeks and again after 8 to 12 weeks if needed, according to specific blood pressure criteria; median final dose in the largest study (n=44; median age: 10 years): 4 mg/kg once daily (Ref)

10 to 20 kg: Initial: 37.5 mg once daily

21 to 40 kg: Initial: 75 mg once daily

>40 kg: Initial: 150 mg once daily

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Children ≥6 years and Adolescents:

Mild to severe impairment: Hypertension: There are no pediatric specific recommendations; based on experience in adult patients, no dosage adjustment necessary unless the patient is also volume depleted.

Hemodialysis: Not removed by hemodialysis

Dosing: Hepatic Impairment: Pediatric

There are no pediatric specific recommendations; based on experience in adult patients, no dosage adjustment needed.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Unless otherwise indicated, incidences are reported for adults with hypertension.

>10%: Endocrine & metabolic: Hyperkalemia (diabetic nephropathy: 19%)

1% to 10%:

Cardiovascular: Orthostatic hypotension (diabetic nephropathy: 5%)

Gastrointestinal: Diarrhea (3%), dyspepsia (≤2%), heartburn (≤2%)

Nervous system: Dizziness (diabetic nephropathy: 10%), fatigue (4%), orthostatic dizziness (diabetic nephropathy: 5%)

Postmarketing:

Dermatologic: Urticaria

Hematologic & oncologic: Anemia (Simonetti 2007), thrombocytopenia

Hepatic: Hepatitis, increased liver enzymes, jaundice

Hypersensitivity: Anaphylactic shock, anaphylaxis, angioedema

Neuromuscular & skeletal: Increased phosphokinase in blood specimen

Otic: Tinnitus

Contraindications

Hypersensitivity to irbesartan or any component of the formulation; concomitant use with aliskiren in patients with diabetes mellitus

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Canadian labeling: Additional contraindications (not in US labeling): Concomitant use with aliskiren in patients with moderate to severe renal impairment (GFR <60 mL/minute/1.73 m2); concomitant use with ACE inhibitors in patients with diabetic nephropathy; hereditary galactose intolerance, congenital lactase deficiency, or glucose-galactose malabsorption; pregnancy; breastfeeding

Warnings/Precautions

Concerns related to adverse effects:

• Angioedema: Angioedema has been reported rarely with some angiotensin II receptor antagonists (ARBs) and may occur at any time during treatment (especially following first dose). It may involve the head and neck (potentially compromising airway) or the intestine (presenting with abdominal pain). Patients with idiopathic or hereditary angioedema or previous angioedema associated with ACE-inhibitor therapy may be at an increased risk. Prolonged frequent monitoring may be required, especially if tongue, glottis, or larynx are involved, as they are associated with airway obstruction. Patients with a history of airway surgery may have a higher risk of airway obstruction. Discontinue therapy immediately if angioedema occurs. Aggressive early management is critical. Intramuscular (IM) administration of epinephrine may be necessary. Do not readminister to patients who have had angioedema with ARBs.

• Hyperkalemia: May occur; risk factors include renal dysfunction, diabetes mellitus, concomitant use of potassium-sparing diuretics, potassium supplements and/or potassium containing salts. Use cautiously, if at all, with these agents and monitor potassium closely.

• Hypotension: Symptomatic hypotension may occur upon initiation in patients who are salt- or volume-depleted (eg, those treated with high-dose diuretics); correct volume depletion prior to administration. This transient hypotensive response is not a contraindication to further treatment with irbesartan.

• Renal function deterioration: May be associated with deterioration of renal function and/or increases in serum creatinine, particularly in patients with low renal blood flow (eg, renal artery stenosis, chronic kidney disease, severe heart failure, volume depletion) whose glomerular filtration rate (GFR) is dependent on efferent arteriolar vasoconstriction by angiotensin II; deterioration may result in oliguria, acute renal failure, and progressive azotemia. Small increases in serum creatinine may occur following initiation; consider discontinuation only in patients with progressive and/or significant deterioration in renal function.

Disease-related concerns:

• Aortic/mitral stenosis: Use with caution in patients with significant aortic/mitral stenosis.

• Ascites: Generally, avoid use in patients with ascites due to cirrhosis or refractory ascites; if use cannot be avoided in patients with ascites due to cirrhosis, monitor BP and renal function carefully to avoid rapid development of renal failure (AASLD [Runyon 2013]).

• Renal artery stenosis: Use with caution in patients with unstented unilateral/bilateral renal artery stenosis. When unstented bilateral renal artery stenosis is present, use is generally avoided due to the elevated risk of deterioration in renal function unless possible benefits outweigh risks.

• Renal impairment: Use with caution with preexisting renal insufficiency.

Special populations:

• Pregnancy: [US Boxed Warning]: Drugs that act on the renin-angiotensin system can cause injury and death to the developing fetus. Discontinue as soon as possible once pregnancy is detected.

• In Black patients, the BP-lowering effects of ARBs may be less pronounced. The exact mechanism is not known; differences in the renin-angiotensin-aldosterone system, low renin levels, and salt sensitivity more commonly found in Black patients may contribute (Brewster 2013; Helmer 2018; manufacturer's labeling).

• Surgical patients: In patients on chronic ARB therapy, intraoperative hypotension may occur with induction and maintenance of general anesthesia; however, discontinuation of therapy prior to surgery is controversial. If continued preoperatively, avoidance of hypotensive agents during surgery is prudent (Hillis 2011). Based on current research and clinical guidelines in patients undergoing noncardiac surgery, continuing ARB is reasonable in the perioperative period. If ARBs are held before surgery, it is reasonable to restart postoperatively as soon as clinically feasible (ACC/AHA [Fleisher 2014]).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Avapro: 75 mg, 150 mg, 300 mg

Generic: 75 mg, 150 mg, 300 mg

Generic Equivalent Available: US

Yes

Pricing: US

Tablets (Avapro Oral)

75 mg (per each): $8.73

150 mg (per each): $9.19

300 mg (per each): $11.04

Tablets (Irbesartan Oral)

75 mg (per each): $0.44 - $2.92

150 mg (per each): $0.46 - $3.11

300 mg (per each): $0.55 - $3.69

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Avapro: 75 mg, 150 mg, 300 mg

Generic: 75 mg, 150 mg, 300 mg

Administration: Adult

Oral: Administer with or without food.

Administration: Pediatric

Oral: May be administered without regard to food. Capsules may be opened and mixed with small amount of applesauce prior to administration (Ref).

Use: Labeled Indications

Hypertension, chronic: Management of hypertension.

Proteinuric chronic kidney disease, diabetic: Treatment of diabetic nephropathy with an elevated serum creatinine and proteinuria (>300 mg/day) in patients with type 2 diabetes and hypertension.

Use: Off-Label: Adult

Non–ST-elevation acute coronary syndrome; Proteinuric chronic kidney disease, nondiabetic; ST-elevation myocardial infarction

Medication Safety Issues
Sound-alike/look-alike issues:

Avapro may be confused with Anaprox

Metabolism/Transport Effects

Substrate of CYP2C9 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Aliskiren: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Aliskiren may enhance the hypotensive effect of Angiotensin II Receptor Blockers. Aliskiren may enhance the nephrotoxic effect of Angiotensin II Receptor Blockers. Management: Aliskiren use with ACEIs or ARBs in patients with diabetes is contraindicated. Combined use in other patients should be avoided, particularly when CrCl is less than 60 mL/min. If combined, monitor potassium, creatinine, and blood pressure closely. Risk D: Consider therapy modification

Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider therapy modification

Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Angiotensin II: Receptor Blockers may diminish the therapeutic effect of Angiotensin II. Risk C: Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: Angiotensin II Receptor Blockers may enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. Angiotensin II Receptor Blockers may increase the serum concentration of Angiotensin-Converting Enzyme Inhibitors. Management: Use of telmisartan and ramipril is not recommended. It is not clear if any other combination of an ACE inhibitor and an ARB would be any safer. Consider alternatives when possible. Monitor blood pressure, renal function, and potassium if combined. Risk D: Consider therapy modification

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy

Arginine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Brigatinib: May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents. Risk C: Monitor therapy

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Bromperidol: May diminish the hypotensive effect of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Risk X: Avoid combination

Dapoxetine: May enhance the orthostatic hypotensive effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Dexmethylphenidate: May diminish the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy

Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Drospirenone-Containing Products: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Risk C: Monitor therapy

Eplerenone: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Finerenone: Angiotensin II Receptor Blockers may enhance the hyperkalemic effect of Finerenone. Risk C: Monitor therapy

Flunarizine: May enhance the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy

Heparin: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Heparins (Low Molecular Weight): May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Herbal Products with Blood Pressure Increasing Effects: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Herbal Products with Blood Pressure Lowering Effects: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy

Indoramin: May enhance the hypotensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Foslevodopa. Risk C: Monitor therapy

Lithium: Angiotensin II Receptor Blockers may increase the serum concentration of Lithium. Management: Initiate lithium at lower doses in patients receiving an angiotensin II receptor blocker (ARB). Consider lithium dose reductions in patients stable on lithium therapy who are initiating an ARB. Monitor lithium concentrations closely when combined. Risk D: Consider therapy modification

Loop Diuretics: May enhance the hypotensive effect of Angiotensin II Receptor Blockers. Loop Diuretics may enhance the nephrotoxic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nicorandil: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: Angiotensin II Receptor Blockers may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Angiotensin II Receptor Blockers. The combination of these two agents may also significantly decrease glomerular filtration and renal function. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents (Topical): May diminish the therapeutic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider therapy modification

Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk C: Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Polyethylene Glycol-Electrolyte Solution: Angiotensin II Receptor Blockers may enhance the nephrotoxic effect of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor therapy

Potassium Salts: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Potassium-Sparing Diuretics: Angiotensin II Receptor Blockers may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy

Prazosin: Antihypertensive Agents may enhance the hypotensive effect of Prazosin. Risk C: Monitor therapy

Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Ranolazine: May enhance the adverse/toxic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Repaglinide: Irbesartan may increase the serum concentration of Repaglinide. Risk C: Monitor therapy

Silodosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Sodium Phosphates: Angiotensin II Receptor Blockers may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor therapy

Sparsentan: May enhance the adverse/toxic effect of Angiotensin II Receptor Blockers. Risk X: Avoid combination

Tacrolimus (Systemic): Angiotensin II Receptor Blockers may enhance the hyperkalemic effect of Tacrolimus (Systemic). Risk C: Monitor therapy

Terazosin: Antihypertensive Agents may enhance the hypotensive effect of Terazosin. Risk C: Monitor therapy

Tolvaptan: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Trimethoprim: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Urapidil: Antihypertensive Agents may enhance the hypotensive effect of Urapidil. Risk C: Monitor therapy

Reproductive Considerations

Avoid use of an angiotensin II receptor blocker (ARB) in patients who may become pregnant and who are not using effective contraception (ADA 2021).

Medications considered acceptable for the treatment of chronic hypertension during pregnancy may generally be used in patients trying to conceive. ARBs are fetotoxic. Transition patients prior to conception to an agent preferred for use during pregnancy unless treatment with an ARB is absolutely necessary (ACC/AHA [Whelton 2018]; ACOG 2019; NICE 2019).

When an ARB is used for the treatment of proteinuric chronic kidney disease in patients who could become pregnant, discontinue use at the first positive pregnancy test (ADA 2021; Fakhouri 2023).

Pregnancy Considerations

Drugs that act on the renin-angiotensin system can cause injury and death to the developing fetus. Exposure to an angiotensin II receptor blocker (ARB) during the first trimester of pregnancy may be associated with an increased risk of fetal malformations (ACOG 2019; ESC [Regitz-Zagrosek 2018]). Following exposure during the second or third trimesters, drugs that act on the renin-angiotensin system are associated with oligohydramnios. Oligohydramnios, due to decreased fetal kidney function, may lead to fetal lung hypoplasia and skeletal malformations. Oligohydramnios may not appear until after an irreversible fetal injury has occurred. ARB use during pregnancy is also associated with anuria, hypotension, kidney failure, skull hypoplasia, and death in the fetus/neonate. Monitor infants exposed to an ARB in utero for hyperkalemia, hypotension, and oliguria. Exchange transfusions or dialysis may be required to reverse hypotension or improve renal function.

Chronic maternal hypertension is also associated with adverse events in the fetus/infant. Chronic maternal hypertension may increase the risk of birth defects, low birth weight, premature delivery, stillbirth, and neonatal death. Actual fetal/neonatal risks may be related to the duration and severity of maternal hypertension. Untreated chronic hypertension may also increase the risks of adverse maternal outcomes, including gestational diabetes, preeclampsia, delivery complications, stroke, and myocardial infarction (ACOG 2019).

Discontinue ARBs as soon as possible once pregnancy is detected. Agents other than an ARB are recommended for the treatment of chronic hypertension during pregnancy (ACOG 2019; ESC [Cífková 2020]; ESC [Regitz-Zagrosek 2018]; SOGC [Magee 2022]). Closely monitor patients exposed to an ARB during pregnancy with serial ultrasounds.

ARBs are not recommended for the treatment of proteinuric chronic kidney disease during pregnancy (Fakhouri 2023).

Breastfeeding Considerations

It is not known if irbesartan is present in breast milk.

Due to the potential for serious adverse reactions in the breastfeeding infant, breastfeeding is not recommended by the manufacturer. When treatment for hypertension is needed in a breastfeeding patient, consider use of an agent other than an angiotensin II receptor blocker (ESC [Cífková 2020]; NICE 2019).

Monitoring Parameters

Blood pressure; serum electrolytes (eg, potassium [especially in patients on concomitant potassium-sparing diuretics, potassium supplements, and/or potassium-containing salts]); serum creatinine; BUN.

Mechanism of Action

Irbesartan is an angiotensin receptor antagonist. Angiotensin II acts as a vasoconstrictor. In addition to causing direct vasoconstriction, angiotensin II also stimulates the release of aldosterone. Once aldosterone is released, sodium as well as water are reabsorbed. The end result is an elevation in blood pressure. Irbesartan binds to the AT1 angiotensin II receptor. This binding prevents angiotensin II from binding to the receptor thereby blocking the vasoconstriction and the aldosterone secreting effects of angiotensin II.

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Peak effect: 1 to 2 hours

Maximum effect: 3-6 hours postdose; with chronic dosing maximum effect: ~2 weeks

Duration: >24 hours

Absorption: Rapid and complete

Distribution: Vd: 53 to 93 L

Protein binding, plasma: 90%, primarily to albumin and alpha-1 acid glycoprotein

Metabolism: Hepatic, via glucuronide conjugation and oxidation; oxidation occurs primarily by cytochrome P450 isoenzyme CYP2C9

Bioavailability: 60% to 80%

Half-life elimination: Terminal: 11 to 15 hours

Time to peak, serum: 1.5 to 2 hours

Excretion: Feces (80%); urine (20%)

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Race/ethnicity: In healthy black patients, AUC values were approximately 25% greater than white patients.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Andaran | Aprovel | Arena | Avansart | Gizlan | Irbea | Irbigen;
  • (AR) Argentina: Adana | Aprovel | Avapro;
  • (AT) Austria: Irbesartan G.L. | Irbesartan sandoz | Irbesartan Stada;
  • (AU) Australia: Abisart | Apo irbesartan | Avapro | Avsartan | Chemmart irbesartan | Irbesartan actavis | Irbesartan an | Irbesartan drla | Irbesartan ga | Irbesartan gh | Irbesartan rbx | Irbesartan sandoz | Irbesartan Winthrop | Irprestan | Karbesat | Karvea | Stada irbesartan | Terry white chemists irbesartan;
  • (BD) Bangladesh: Arbit | Arbitan | Cavapro | Ibsan | Irbes | Isart;
  • (BE) Belgium: Aprovel | Irbesartan actavis | Irbesartan Apotex | Irbesartan eg | Irbesartan mylan | Irbesartan sandoz | Irbesartan teva;
  • (BF) Burkina Faso: Andaran | Aprovel;
  • (BG) Bulgaria: Aprovel | Irbec | Irbesan | Irbesso | Irprestan;
  • (BR) Brazil: Aprovel | Avapro | Irbesartana;
  • (CH) Switzerland: Aprovel | Irbesartan actavis | Irbesartan Mepha | Irbesartan sandoz | Irbesartan Spirig | Irbesartan spirig hc | Irbesartan zentiva | Karvea;
  • (CI) Côte d'Ivoire: Andaran | Aprozar | Aradex | Avepro;
  • (CL) Chile: Aprovel | Irbevitae;
  • (CN) China: An bo wei | An lai | Aprovel | Ge ping | Greats | Ji jia | Ruo peng | Su shi | Xin ping | Yi da li;
  • (CO) Colombia: Aprovel | Araplus | Corional | Girenoxin | Iberten | Irbeprex | Irbesartan sandoz | Irbett | Irbevitae | Irbigen | Mofilet | Nadicip;
  • (CZ) Czech Republic: Aprovel | Ifirmasta | Irbesartan +Pharma | Irbesartan actavis | Irbesartan Apotex | Irbesartan aurovitas | Irbesartan mylan | Irbesartan Winthrop | Isame;
  • (DE) Germany: Aprovel | Generitan | Ifirmasta | Irbepress | Irbesartan 1A Pharma | Irbesartan abz | Irbesartan actavis | Irbesartan AL | Irbesartan aurobindo | Irbesartan basics | Irbesartan Bluefish | Irbesartan CT | Irbesartan Dexcel | Irbesartan Fair Med | Irbesartan Hennig | Irbesartan Heumann | Irbesartan Hexal | Irbesartan hormosan | Irbesartan micro labs | Irbesartan mylan | Irbesartan pfizer | Irbesartan puren | Irbesartan ratiopharm | Irbesartan Stada | Irbesartan zentiva | Karvea;
  • (DO) Dominican Republic: Aprobrit | Aprovel | Aramax | Cardiber | Carditran | Iberpres | Ibersar | Iberterol | Irbesartan calox | Irbesartan if | Irbesartan lam | Irbesartan Normon | Iveprax | Keotan | Tensiber | Vassluten;
  • (EC) Ecuador: Acepress | Aprovel | Corional | Irbe letic | Irbecross | Irbesartan mk | Irbetan | Irbett | Sartabe;
  • (EE) Estonia: Aprovel;
  • (EG) Egypt: Aprovel | Irban | Irbedrin | Irbefutal | Irbetan | Kansartan | Sartaless | X tension;
  • (ES) Spain: Aprovel | Ifirmasta | Irbesartan actavis | Irbesartan Almus | Irbesartan Alter | Irbesartan Apotex | Irbesartan aristo | Irbesartan aurobindo | Irbesartan Bexal | Irbesartan Cinfa | Irbesartan Combix | Irbesartan Davur | Irbesartan Kern Pharma | Irbesartan Mabo | Irbesartan mylan | Irbesartan mylan pharmaceuticals | Irbesartan Normon | Irbesartan Pensa | Irbesartan Qualigen | Irbesartan Ranbaxy | Irbesartan ratiopharm | Irbesartan sandoz | Irbesartan Stada | Irbesartan tarbis | Irbesartan tecnigen | Irbesartan teva | Irbesartan Urquima | Irbesartan zentiva | Karvea;
  • (ET) Ethiopia: Arena | Converium | Irbesartan sandoz | Irbewin | Irovel;
  • (FI) Finland: Aprovel;
  • (FR) France: Aprovel | Ifirmasta | Irbesartan accord | Irbesartan actavis | Irbesartan Alter | Irbesartan arrow | Irbesartan biogaran | Irbesartan cristers | Irbesartan eg | Irbesartan evolugen | Irbesartan isomed | Irbesartan mylan | Irbesartan Phr lab | Irbesartan Ranbaxy | Irbesartan ratiopharm | Irbesartan sandoz | Irbesartan teva | Irbesartan zentiva | Irbesartan Zydus;
  • (GB) United Kingdom: Aprovel | Ifirmasta | Irbesartan arrow | Irbesartan milpharm | Irbesartan sandoz | Irbesartan teva | Sabervel;
  • (GR) Greece: Aprovel | Besartan | Irbegen | Irbepress | Irbesartan accord | Irbesartan actavis | Irbesartan generics | Irbesartan sandoz | Irbesartan zentiva | Irbesartan/liconsa | Irbotens | Irven | Karvea | Karvofil | Lucidel | Menago "adelco" | Piesiton | Roverin;
  • (HK) Hong Kong: Aprovel | Eurbesar | Irbegen | Irbesartan jubilant | Irbesartan sandoz | Irbetan | Irprestan | Pms irbesartan | Presolin;
  • (HR) Croatia: Aprovel;
  • (HU) Hungary: Abonda | Aprovel | Ebrit | Irabel | Irbesartan sandoz | Irbesartan teva | Irbesartan Winthrop | Irbezep | Irprestan | Pribercor | Sabervel;
  • (ID) Indonesia: Aprovel | Arbiten-i | Elzar | Fritens | Irbedox | Iretensa | Irtan | Irvask | Irvell | Nortens | Tensira;
  • (IE) Ireland: Aprovel | Ifirmasta | Irbesan | Irbesartan accord | Irbesartan rowa | Irbesartan Winthrop | Irprestan;
  • (IL) Israel: Irban;
  • (IN) India: Insat | Irbest | Irovel | Sebri | Xarb;
  • (IT) Italy: Aprovel | Assipress | Ifirmasta | Irbecor | Irbesartan accord | Irbesartan actavis | Irbesartan Age | Irbesartan aurobindo | Irbesartan doc generici | Irbesartan eg | Irbesartan mylan | Irbesartan Pns | Irbesartan Ranbaxy | Irbesartan sandoz | Irbesartan tecnigen | Irbesartan zentiva | Irbetens | Karvea | Rabesat | Retensir | Sykratan;
  • (JO) Jordan: Converium | Irbegen | Procard | Vivazac;
  • (JP) Japan: Avapro | Irbesartan chemipha | Irbesartan dspb | Irbesartan ee | Irbesartan kn | Irbesartan nichiiko | Irbesartan nipro | Irbesartan ohara | Irbesartan sawai | Irbesartan towa | Irbetan;
  • (KE) Kenya: Andaran | Aprovel | Converium | Irbetan | Irbis | Irovel | Medisart | Rycardon;
  • (KR) Korea, Republic of: Abeltan | Anysartan | Aprovel | Aprtan | Arb ib | Bivel | Cellprovel | Ibefro | Ibepro | Ibera | Ibero | Ibertan | Ibesa | Ibesdil | Ibetan | Inno.n abeltan | Irbel | Irbera | Irbetan | Irbetel | Irsartan | Isartan | Izabeltan | Izarbelltan | Izatan | Winapro;
  • (KW) Kuwait: Aprovel | Vivazac;
  • (LB) Lebanon: Andaran | Aprovel | Converium | Gizlan | Ibecard | Irbavel | Irbesartan arrow | Ziorel;
  • (LT) Lithuania: Aprovel | Irbesartan Ranbaxy | Irovel;
  • (LU) Luxembourg: Aprovel | Irbesartan eg | Irbesartan mylan | Irbesartan ratiopharm | Irbesartan sandoz;
  • (LV) Latvia: Aprovel;
  • (MA) Morocco: Aprovel | Arapro | Avacor | Avepro | Cardivel | Icard | Irbesar sun | Irphi | Irvel | Novortan | Vepran | Vezar;
  • (MX) Mexico: Aprovel | Auseba | Avapro | Brandul | Diogena | Dulastat | Irbesartan biomep | Irbesartan bioresearch | Irbesartan novag | Irbesartan ultra | Landaratan | Lullent | Prebiodel | Zatrivir | Zoxbe;
  • (MY) Malaysia: Aprovel | Besartin | Bezartan | Converium | Cruzor | Irbel | Irbemac | Irbis | Irstran;
  • (NG) Nigeria: Blueirbe | Ibsar | Irbesartan sandoz;
  • (NL) Netherlands: Aprovel | Ardinel | Irbesartan focus | Irbesartan xiromed | Sabervel;
  • (NO) Norway: Aprovel | Ifirmasta | Irbesartan actavis | Irbesartan sandoz;
  • (PE) Peru: Aprovel | Araplus | Cardiovel | Chestinor | Ecartan | Iberlip | Iprodial | Irbecard | Irbelab | Irbesamed | Irbesel | Irbett | Irbevitae | Irbis h | Irovel | Mesartin | Normopress | Probertan | Tenssaliv | Velapro;
  • (PH) Philippines: Aprovel | Arbez | Bezart | Idezar | Irbegen | Irbemed | Irbenox | Irbepro | Irbesartan Winthrop | Irbevex | Irbez | Irbezil | Irbezyd | Irvex | Izart | Ritemed irbesartan | Virbez;
  • (PK) Pakistan: Accord | Apraise | Aprovel | Arbi | Arbista | B sart | Besart | Gooday | Irbisaff | Isart | Kanbesartan | Maxten | Vepro | Zepose;
  • (PL) Poland: Aprovel | Ifirmasta | Irbesartan aurovitas | Irbesartan pfizer | Irprestan;
  • (PR) Puerto Rico: Avapro;
  • (PT) Portugal: Aprovel | Besantil | Cispenta | Irbesartan actavis | Irbesartan Alter | Irbesartan aurobindo | Irbesartan Azevedos | Irbesartan basi | Irbesartan Bluefish | Irbesartan Bluepharma | Irbesartan ciclum | Irbesartan generis | Irbesartan Germed | Irbesartan GP | Irbesartan Krka | Irbesartan Labesfal | Irbesartan Labur | Irbesartan Mepha | Irbesartan mylan | Irbesartan pentafarma | Irbesartan pharmakern | Irbesartan ratiopharm | Irbesartan Sarb | Irbesartan Stada | Irbesartan tetrafarma | Irbesartan teva | Irbesartan Wynn | Irbesartan zentiva | Zarterolan | Zipertensin;
  • (PY) Paraguay: Angiotensil | Aprovel;
  • (QA) Qatar: Aprovel | Converium | Gizlan | Vivazac;
  • (RO) Romania: Aprovel | Ifirmasta | Irbegamma | Irbesartan aurobindo | Irbesartan galenica | Irbesartan hf | Irbesartan sandoz | Irbesartan terapia | Irbesartan teva | Irbesartan torrent | Irbesartan zentiva | Irprestan;
  • (RU) Russian Federation: Aprovel | Firmasta | Ibertan | Irsar;
  • (SA) Saudi Arabia: Aprovel | Arena | Gizlan | Irbegen | Irbetel | Irovel | Irsotan | Vivazac;
  • (SE) Sweden: Aprovel | Ifirmasta | Irbesartan accord | Irbesartan actavis | Irbesartan aurobindo | Irbesartan Bluefish | Irbesartan jubilant | Irbesartan mylan | Irbesartan Ranbaxy | Irbesartan sandoz | Irbesartan Stada | Irbesartan teva | Irbesartan zentiva;
  • (SG) Singapore: Aprovel | Irprestan | Pms irbesartan | Tensiber;
  • (SI) Slovenia: Aprovel | Iraben | Irbesartan actavis | Irbesartan teva | Irtucalan;
  • (SK) Slovakia: Aprovel | Ifirmasta | Irbenahyp | Irbesartan accord | Irbesartan actavis | Irbesartan mylan | Irbesartan sandoz | Irbesartan teva | Irbesartan Winthrop;
  • (SV) El Salvador: Irbesarteg;
  • (TH) Thailand: Aprovel | Besanta | Irbenox | Irbesartan gpo | Optima | Presolin | Tobisan;
  • (TN) Tunisia: Aprovel | Aprozar | Araven | Irbegen | Irbesar | Irbesartan pfizer | Irby;
  • (TR) Turkey: Arbesta | Irbecor | Irda | Irprestan | Karvea | Rebevea;
  • (TW) Taiwan: Alvoprel | Aprotan | Aprovel | Besitan | Bestan | Heipo | Ibesaa | Irbeprovel | Irbest | Irbetan | Irbis h | Irsutan | Zydus Irbesartan;
  • (UA) Ukraine: Aprovel | Converium | Irbetan;
  • (UG) Uganda: Andaran | Gizlan 150 | Irbis h;
  • (UY) Uruguay: Aprovel | Noasartan;
  • (VE) Venezuela, Bolivarian Republic of: Aprovel | Ariven | Irbertan | Vassluten;
  • (VN) Viet Nam: Atisartan | Belsan | Dovel | Hatlop | Ibartain mr | Ircovas | Savi Irbesartan | Spirbera;
  • (ZA) South Africa: Adco Irbesartan | Antosart | Aprovel | Dynarb | Irbewin | Irtanel | Isart | Jubitan;
  • (ZM) Zambia: Irbis h;
  • (ZW) Zimbabwe: Andaran | Irbis h
  1. American College of Obstetricians and Gynecologists (ACOG). ACOG practice bulletin no. 203: chronic hypertension in pregnancy. Obstet Gynecol. 2019;133(1):e26-e50. [PubMed 30575676]
  2. American Diabetes Association (ADA). Standards of medical care in diabetes–2021. Diabetes Care. 2021;44(suppl 1):S1-S232. https://care.diabetesjournals.org/content/44/Supplement_1. Accessed January 12, 2021.
  3. Amsterdam EA, Wenger NK, Brindis RG, et al; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons; American Association for Clinical Chemistry. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published correction appears in J Am Coll Cardiol. 2014;64(24):2713-2714]. J Am Coll Cardiol. 2014;64(24):e139-e228. doi: 10.1016/j.jacc.2014.09.017. [PubMed 25260718]
  4. Avapro (irbesartan) [prescribing information]. Bridgeton, NJ: Sanofi-Aventis US LLC; May 2021.
  5. Avapro (irbesartan) [prescribing information]. Bridgeton, NJ: Sanofi-Aventis US LLC; December 2020.
  6. Avapro (irbesartan) [prescribing information]. Bridgewater, NJ: Sanofi-Aventis US LLC; September 2021.
  7. Avapro (irbesartan) [product monograph]. Laval, Quebec, Canada: Sanofi-Aventis Canada Inc; November 2022.
  8. Beltrami L, Zanichelli A, Zingale L, Vacchini R, Carugo S, Cicardi M. Long-term follow-up of 111 patients with angiotensin-converting enzyme inhibitor-related angioedema. J Hypertens. 2011;29(11):2273-2277. doi:10.1097/HJH.0b013e32834b4b9b [PubMed 21970934]
  9. Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(2):1014-1048. doi:10.1002/hep.31884 [PubMed 33942342]
  10. Brewster LM, Seedat YK. Why do hypertensive patients of African ancestry respond better to calcium blockers and diuretics than to ACE inhibitors and β-adrenergic blockers? A systematic review. BMC Med. 2013;11:141. doi:10.1186/1741-7015-11-141 [PubMed 23721258]
  11. Brooke BS, Habashi JP, Judge DP, et al, “Angiotensin II Blockade and Aortic-Root Dilation in Marfan's Syndrome,” N Engl J Med, 2008, 358(26):2787-95. [PubMed 18579813]
  12. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, "Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada," Can J Diabetes, 2013, 35(Suppl 1):1-212.
  13. Cattran DC, Appel GB, Coppo R. IgA nephropathy: treatment and prognosis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed December 13, 2023.
  14. Chobanian AV, Bakris GL, Black HR, et al, “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report,” JAMA, 2003, 289(19):2560-72. [PubMed 12748199]
  15. Cífková R, Johnson MR, Kahan T, et al. Peripartum management of hypertension: a position paper of the ESC Council on Hypertension and the European Society of Hypertension. Eur Heart J Cardiovasc Pharmacother. 2020;6(6):384-393. doi:10.1093/ehjcvp/pvz082 [PubMed 31841131]
  16. Conlin P, Moore T, Swartz S, et al, “Effect of Indomethacin on Blood Pressure Lowering by Captopril and Losartan in Hypertensive Patients,” Hypertension, 2000, 36(3):461-5. [PubMed 10988282]
  17. Epstein BJ and Gums JG, “Angiotensin Receptor Blockers Versus ACE Inhibitors: Prevention of Death and Myocardial Infarction in High-Risk Populations,” Ann Pharmacother, 2005, 39(3):470-80. [PubMed 15701766]
  18. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011;128 Suppl 5:S213-256. [PubMed 22084329]
  19. Expert opinion. Senior Renal Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
  20. Fakhouri F, Schwotzer N, Cabiddu G, et al. Glomerular diseases in pregnancy: pragmatic recommendations for clinical management. Kidney Int. 2023;103(2):264-281. doi:10.1016/j.kint.2022.10.029 [PubMed 36481180]
  21. Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2014;130:1749-1767. doi: 10.1161/CIR.0000000000000095. [PubMed 25070666]
  22. Fihn SD, Gardin JM, Abrams J, et al, “2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons,” Circulation, 2012, 126(25):3097-137. [PubMed 23166211]
  23. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130(24):e278-e333. [PubMed 25085961]
  24. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3). pii: e20171904. [PubMed 28827377]
  25. Franscini LM, Von Vigier RO, Pfister R, et al, "Effectiveness and Safety of the Angiotensin II Antagonist Irbesartan in Children With Chronic Kidney Diseases," Am J Hypertens, 2002, 15(12):1057-63. [PubMed 12460701]
  26. Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5):1889-1916. doi: 10.1210/jc.2015-4061. [PubMed 26934393]
  27. Gartenmann AC, Fossali E, von Vigier RO, et al, "Better Renoprotective Effect of Angiotensin II Antagonist Compared to Dihydropyridine Calcium Channel Blocker in Childhood," Kidney Int, 2003, 64(4):1450-4. [PubMed 12969165]
  28. Gersak K, Cvijic M, and Cerar LK, "Angiotensin II Receptor Blockers in Pregnancy: A Report of Five Cases," Reprod Toxicol, 2009, 28(1):109-12. [PubMed 19491003]
  29. Go AS, Bauman M, King SM, et al. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention [published online November 15, 2013]. Hypertension. [PubMed 24243703]
  30. Guyer AC, Banerji A. ACE inhibitor-induced angioedema. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed April 13, 2021.
  31. Helmer A, Slater N, Smithgall S. A review of ACE inhibitors and ARBs in black patients with hypertension. Ann Pharmacother. 2018;52(11):1143-1151. doi:10.1177/1060028018779082 [PubMed 29808707]
  32. Hillis LD, Smith PK, Anderson JL, et al, “2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines,” Circulation, 2011, 124(23):2610-42. [PubMed 22064600]
  33. Hogg RJ, Portman RJ, Milliner D, et al, "Evaluation and Management of Proteinuria and Nephrotic Syndrome in Children: Recommendations From a Pediatric Nephrology Panel Established at the National Kidney Foundation Conference on Proteinuria, Albuminuria, Risk, Assessment, Detection, and Elimination (PARADE)," Pediatrics, 2000, 105(6):1242-9. [PubMed 10835064]
  34. James PA, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8) [published online December 18, 2013]. JAMA. [PubMed 24352797]
  35. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society [published online March 28, 2014]. Circulation. [PubMed 24682347]
  36. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int. 2021b;99(3S):S1-S87. doi:10.1016/j.kint.2020.11.003 [PubMed 33637192]
  37. Kidney Disease: Improving Global Outcomes (KDIGO). Chapter 10: immunoglobulin A nephropathy. Kidney Int Suppl (2011). 2012;2(2):209-217. doi:10.1038/kisup.2012.23 [PubMed 25018935]
  38. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guidelines for the evaluation and management of chronic kidney disease. Kidney Inter, Suppl. 2013;3:1-150.
  39. Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int. 2022;102(suppl 5):S1-S127. doi:10.1016/j.kint.2022.06.008 [PubMed 36272764]
  40. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int. 2021a;100(suppl 4):S1-S276. doi:10.1016/j.kint.2021.05.021 [PubMed 34556256]
  41. Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2020 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int. 2020;98(4S):S1-S115. doi:10.1016/j.kint.2020.06.019 [PubMed 32998798]
  42. Magee LA, Smith GN, Bloch C, et al. Guideline no. 426: hypertensive disorders of pregnancy: diagnosis, prediction, prevention, and management. J Obstet Gynaecol Can. 2022;44(5):547-571.e1. doi:10.1016/j.jogc.2022.03.002 [PubMed 35577426]
  43. Mann JFE, Bakris GL. Antihypertensive therapy and progression of nondiabetic chronic kidney disease in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed April 12, 2021b.
  44. Mann JFE, Flack JM. Choice of drug therapy in primary (essential) hypertension. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 7, 2023.
  45. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents, “The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents,” Pediatrics, 2004, 114 (2 Suppl):555-76. [PubMed 15286277]
  46. National Institute for Health and Care Excellence (NICE). NICE guideline hypertension in pregnancy: diagnosis and management. www.nice.org.uk/guidance/ng133. Published June 25, 2019. Accessed December 1, 2022.
  47. Nishimura RA, Otto CM, Bonow RO, et al, 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(23):2440-92. doi: 10.1161/CIR.0000000000000029. [PubMed 24589852]
  48. O'Gara PT, Kushner FG, Ascheim DD, et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):e362-e425. doi: 10.1161/CIR.0b013e3182742cf6. [PubMed 23247304]
  49. Perkovic V. Treatment of diabetic kidney disease. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 2, 2023.
  50. Pfeffer MA, McMurray JJ, Velazquez EJ, et al; Valsartan in Acute Myocardial Infarction Trial Investigators. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med. 2003;349(20):1893-1906. [PubMed 14610160]
  51. Rasmussen ER, Pottegård A, Bygum A, von Buchwald C, Homøe P, Hallas J. Angiotensin II receptor blockers are safe in patients with prior angioedema related to angiotensin-converting enzyme inhibitors - a nationwide registry-based cohort study. J Intern Med. 2019;285(5):553-561. doi:10.1111/joim.12867 [PubMed 30618189]
  52. Refer to manufacturer's labeling.
  53. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al; ESC Scientific Document Group. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165-3241. doi:10.1093/eurheartj/ehy340 [PubMed 30165544]
  54. Rosendorff C, Lackland DT, Allison M, et al; American Heart Association, American College of Cardiology, and American Society of Hypertension. Treatment of hypertension in patients with coronary artery disease: a scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. J Am Soc Hypertens. 2015;9(6):453-498. doi: 10.1016/j.jash.2015.03.002. [PubMed 25840695]
  55. Runyon BA; AASLD. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013;57(4):1651-1653. doi:10.1002/hep.26359 [PubMed 23463403]
  56. Sakarcan A, Tenney F, Wilson JT, et al, "The Pharmacokinetics of Irbesartan in Hypertensive Children and Adolescents," J Clin Pharmacol, 2001, 41(7):742-9. [PubMed 11452706]
  57. Sica DA, Marino MR, Hammett JL, Ferreira I, Gehr TW, Ford NF. The pharmacokinetics of irbesartan in renal failure and maintenance hemodialysis. Clin Pharmacol Ther. 1997;62(6):610-618. doi:10.1016/S0009-9236(97)90080-1 [PubMed 9433389]
  58. Simonetti GD, Bianchetti MG, Konrad M, et al, "Severe Anemia Caused by the Angiotensin Receptor Blocker Irbesartan After Renal Transplantation," Pediatr Nephrol, 2007, 22(5):756-7. [PubMed 17216246]
  59. Sipahi I, Debanne SM, Rowland DY, et al, “Angiotensin-Receptor Blockade and Risk of Cancer: Meta-Analysis of Randomised Controlled Trials,” Lancet Oncol, 2010, 11(7):627-36. [PubMed 20542468]
  60. Smith SC Jr, Benjamin EJ, Bonow RO, et al, “AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2011 Update: A Guideline From the American Heart Association and American College of Cardiology Foundation,” Circulation, 2011, 124(22):2458-73. [PubMed 22052934]
  61. Toh S, Reichman ME, Houstoun M, et al. Comparative risk for angioedema associated with the use of drugs that target the renin-angiotensin-aldosterone system. Arch Intern Med. 2012;172(20):1582-1589. doi:10.1001/2013.jamainternmed.34 [PubMed 23147456]
  62. von Vigier RO, Zberg PM, Teuffel O, et al, "Preliminary Experience With the Angiotensin II Receptor Antagonist Irbesartan in Chronic Kidney Disease," Eur J Pediatr, 2000, 159(8):590-3. [PubMed 10968237]
  63. Weber MA, Schiffrin EL, White WB, et al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hyperten (Greenwich). 2014;16(1):14-26. [PubMed 24341872]
  64. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Hypertension. 2018;71(6):e13-e115. doi:10.1161/HYP.0000000000000065 [PubMed 29133356]
  65. Zaffanello M, Franchini M, and Fanos V, "New Therapeutic Strategies With Combined Renin-Angiotensin System Inhibitors for Pediatric Nephropathy," Pharmacotherapy, 2008, 28(1):125-30. [PubMed 18154482]
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