eprosartan mesylate

Action

Blocks aldosterone-stimulating and vasoconstrictive effects of angiotensin II at receptor sites in vascular smooth muscles and adrenal glands, decreasing vascular resistance

Availability

Tablets: 400 mg, 600 mg

Indications and dosages

➣ Hypertension

Adults: 600 mg P.O. once daily or in divided doses b.i.d. Total daily dosage range is 400 to 800 mg.

Contraindications

• Hypersensitivity to drug or its components

• Pregnancy or breastfeeding

Precautions

Use cautiously in:

• hypotension, heart failure, renal or hepatic impairment, obstructive biliary disorders, volume or sodium depletion

• concurrent high-dose diuretic therapy

• females of childbearing age

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

Administration

• Give initial dose in supervised medical setting, and monitor blood pressure for 2 hours after administration.

• Know that drug may be given alone or with other antihypertensives.

• Be aware that black patients have a higher risk of angioedema.

• Be prepared to treat transient hypotension by placing patient in supine position and giving I.V. normal saline infusion as needed.

Adverse reactions

CNS: dizziness, fatigue, headache, syncope

CV: hypotension, chest pain, peripheral edema

EENT: sinus disorders

GI: nausea, diarrhea, constipation, abdominal pain, dry mouth

GU: albuminuria, renal failure

Hepatic: hepatitis

Metabolic: gout, hyperkalemia

Musculoskeletal: joint pain, back pain, muscle weakness

Respiratory: upper respiratory tract infection, cough, bronchitis

Skin: angioedema

Other: dental pain, fever, facial edema

Interactions

Drug-drug. Antihypertensives, diuretics: increased risk of hypotension

Nonsteroidal anti-inflammatory drugs: decreased antihypertensive effect of eprosartan

Potassium-sparing diuretics, potassium supplements: increased risk of hyperkalemia

Drug-diagnostic tests. Absolute neutrophil count, hemoglobin, platelets, white blood cells: decreased

Albumin, creatinine, liver function tests, serum BUN: elevated levels

Drug-food. Salt substitutes containing potassium: increased risk of hyperkalemia

Drug-herbs. Ephedra (ma huang): antagonism of eprosartan action

Drug-behaviors. Alcohol use: increased CNS depression

Patient monitoring

• Monitor vital signs, particularly for hypotension after administration.

• Assess cardiovascular status, especially for chest pain, syncope, and edema.

• Monitor liver and kidney function test results, watching for drug-induced hepatitis or renal failure.

• Assess respiratory status. Stay alert for dry, persistent cough and signs and symptoms of respiratory infections.

• Monitor electrolyte levels, and watch for signs and symptoms of hyperkalemia.

Patient teaching

• Instruct patient to take drug at same time each day, with or without food.

See Inform patient that drug may cause angioedema. Instruct him to immediately report facial or lip swelling, fever, or sore throat.

See Advise patient to immediately report chest pain, fainting, decreased urine output, unusual tiredness, yellowing of skin or eyes, or swelling.

See Tell female patient to contact prescriber right away if she suspects she's pregnant.

• Caution female not to breastfeed while taking drug.

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