Drug Interactions of Angiotensin Receptor Blockers (ARBs)

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Angiotensin Receptor Blockers (ARBs) may interact significantly with medications such as Aliskiren, ACE Inhibitors, Lithium, CYP2C9 inhibitors, CYP3A4 Inhibitors, CYP3A4 Inducers, Potassium Sparing Diuretics, Trimethoprim, NSAIDs and Insulin.

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Drug Interactions of Antihypertensives (Part 2) (Drug Interactions of Angiotensin Receptor Blockers (ARBs)):

Drug Interactions of Antihypertensives (Part 2) ( Drug Interactions of Angiotensin Receptor Blockers (ARBs )) Dr. P.Naina Mohamed PhD Pharmacologist

Introduction:

Introduction An interaction between one or more coadministered medications leading to alteration of effectiveness or toxicity of any of the coadministered medications, is defined as Adverse Drug I nteraction . Drug interactions can be caused by prescription and over-the-counter (OTC) medications, herbal products or vitamins, foods, diseases, and genetics (family history). It is estimated that people over 65 take an average of seven drugs at any one time to treat a variety of illnesses. The probability of drug interaction is very high, with this amount of medicine use.

Antihypertensives:

Antihypertensives The common Antihypertensives include… Angiotensin converting enzyme inhibitors (ACEIs) Angiotensin receptor blockers (ARBs) Direct Renin Inhibitors (DRIs) Calcium channel blockers (CCBs) Diuretics Adrenergic Beta Blockers Adrenergic Alpha Blockers

Angiotensin Receptor Blockers (ARBs) :

Angiotensin Receptor Blockers (ARBs) Commonly prescribed Angiotensin II receptor Blockers (ARBs ) include… Losartan Candesartan Irbesartan Valsartan Telmisartan Eprosartan Olmesartan

ARBs & Aliskiren:

ARBs & Aliskiren Concomitant use of ARBs and Aliskiren should also be avoided in patients with renal impairment.

ARBs and ACEIs:

ARBs and ACEIs Concomitant use should generally be avoided. Closely monitor blood pressure, renal function, and electrolytes, if coadministration is necessary.

ARBs and Lithium:

ARBs and Lithium Use caution with coadministration of lithium and ARBs. Monitor serum lithium levels frequently with coadministration .

ARBs and CYP2C9 Inhibitors:

ARBs and CYP2C9 Inhibitors The dose of CYP2C9 inhibitor ( Entacapone , etc.) may need to be adjusted, if concomitant use is required.

ARBs and CYP3A4 Inhibitors:

ARBs and CYP3A4 Inhibitors Coadministration of ARBs and CYP3A4 inhibitors warrants monitoring of adverse reactions. Dose adjustment of ARBs may be required.

ARBs and CYP3A4 Inducers :

ARBs and CYP3A4 Inducers Monitor the ARBs concentrations and/or dose adjustments may be needed, if used concomitantly.

ARBs and Potassium Sparing Diuretics :

ARBs and Potassium Sparing Diuretics Monitor serum potassium levels especially in patients with renal dysfunction or diabetes and the elderly.

ARBs and Trimethoprim:

ARBs and Trimethoprim Concomitant use of Trimethoprim with ARBs, may result in increased risk of hyperkalemia. Closely monitor serum potassium in patients receiving both ARBs and Trimethoprim.

ARBs and NSAIDs:

ARBs and NSAIDs Use caution if ARBs and NSAIDs are coadministered . Monitor for antihypertensive efficacy and assess renal function, especially in patients who are elderly, volume-depleted, or with preexisting renal dysfunction, When concomitant use is required.

ARBs and Insulin:

ARBs and Insulin More frequent glucose monitoring is recommended during the coadministration of ARBs with antidiabetic agents. Insulin dose adjustments may also be needed

Telmisartan and Digoxin:

Telmisartan and Digoxin The blood level of digoxin should be monitored in patients taking Telmisartan along with Digoxin. Because of this interaction, another angiotensin receptor blocker may be more appropriate.

ARBs and Pregnancy or Breast feeding:

ARBs and Pregnancy or Breast feeding Pregnancy: ARBs should be discontinued as soon as possible, if pregnancy occurs during use. ARBs may cause fetal or neonatal injury or death when used during the second or third trimester of pregnancy. Hypotension , hyperkalemia, oliguria, neonatal skull hypoplasia, anuria, and renal failure have occurred in fetuses and neonates. Monitor infants who were exposed to ARBs in utero for hypotension, oliguria, and hyperkalemia. Methyldopa has been widely accepted as safe antihypertensive during pregnancy. Breast Feeding: It is recommended to either discontinue losartan or discontinue nursing, due to the potential for adverse events in the nursing infant.

References:

References Stockley’s Drug Interactions, 9e Karen Baxter http:// www.micromedexsolutions.com http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200815 / http:// circ.ahajournals.org/content/107/24/e215.full http:// www.nature.com/jhh/journal/v14/n1s/abs/1000991a.html

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