azilsartan medoxomil

Action

Inhibits the pressor effects of an angiotensin II infusion in a dose-related manner. Effects of angiotensin II, the principal pressor agent of the renin-angiotensin system, include vasoconstriction, aldosterone release, and sodium reabsorption from the kidneys.

Availability

Tablets: 40 mg, 80 mg

Indications and dosages

➣ Hypertension alone or in combination with other antihypertensives

Adults: 80 mg P.O. daily. Consider a starting dose of 40 mg for patients who are being treated with high-dose diuretics

Contraindications

None

Precautions

Use cautiously in:

• renal impairment, renal artery stenosis

• hypotension in volume- or salt-depleted patients

• patients whose renal function may depend on activity of the renin-angiotensin system

• elderly patients

• pregnant or breastfeeding patients

• children younger than age 18 (safety and efficacy not established).

Administration

• Administer with or without food.

• Correct volume or salt depletion before starting drug.

Adverse reactions

CV: hypotension, orthostatic hypotension

GI: diarrhea

GU: oliguria or progressive azotemia with acute renal failure (rare)

Other: death (rare)

Interactions

Drug-drug. NSAIDs, including selective COX-2 inhibitors: deteriorated renal function, including possible acute renal failure in patients who are elderly, volume-depleted, or who have compromised renal function; attenuated azilsartan antihypertensive effect

Drug-diagnostic tests. Serum creatinine: small reversible increases

Patient monitoring

• Watch for hypotension in volume- or salt-depleted patients, such as those receiving high-dose diuretics.

• Observe for increasing serum creatinine level in patients with moderate to severe renal impairment and worsening renal function in elderly patients and those receiving NSAIDs, including COX-2 inhibitors.

See Watch for oliguria or progressive azotemia that could possibly lead to acute renal failure and death in patients whose renal function depends on the activity of the renin-angiotensin system (such as patients with severe congestive heart failure, renal artery stenosis, or volume depletion).

Patient teaching

• Tell patient to take drug with or without food.

See Instruct patient to promptly report changes in urinary function.

• Advise female patient of childbearing age to immediately notify prescriber if she becomes pregnant.

• Because of the potential for adverse effects in the breastfeeding infant, a decision should be made whether to discontinue breastfeeding or discontinue drug, taking into account importance of drug to the mother.

• As appropriate, review all significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.