Irbesartan

Dual RAS blockade is contraindicated in patients with diabetes. Avoid in patients with renal impairment (GFR <60 mL/min). Associated with increased risks of hypotension, hyperkalemia, and acute renal failure.

Coadministration of irbesartan with drugs that raise serum potassium levels may result in hyperkalemia, sometimes severe.

Dual blockade of the RAS associated with increased risks of hypotension, hyperkalemia, and changes in renal function including acute renal failure. Avoid combined use.

Increases in serum lithium concentrations and lithium toxicity have been reported with concomitant use of irbesartan and lithium. Monitor lithium levels in patients receiving both drugs.

Concomitant use may lead to increases in serum potassium and hyperkalemia, sometimes severe. Monitor serum potassium.

Coadministration may result in deterioration of renal function, including possible acute renal failure, especially in elderly, volume-depleted, or renally compromised patients. Antihypertensive effect may be attenuated.

Increased risk of renal impairment and acute renal failure, especially in elderly or volume-depleted patients. Reduced antihypertensive effects. Monitor renal function periodically.

Coadministration may result in deterioration of renal function, including possible acute renal failure, especially in elderly, volume-depleted, or renally compromised patients. Antihypertensive effect may be attenuated.

Coadministration with drugs that raise serum potassium levels may result in hyperkalemia, sometimes severe. Monitor serum potassium in such patients.

( 7 ) 7.1 Nonsteroidal Anti-inflammatory Agents Including Selective Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors) Irbesartan In patients who are elderly, volume depleted (including those on diuretic therapy), or with compromised renal function, coadministration of NSAIDs, including selective COX-2 inhibitors, with angiotensin II receptor antagonists, including irbesartan, may result in deterioration of renal function, including possible acute renal failure. Therefore, monitor renal function and blood pressure periodically in patients receiving irbesartan and NSAID therapy. Therefore, when AVALIDE (irbesartan and hydrochlorothiazide) tablets and nonsteroidal anti-inflammatory agents are used concomitantly, the patient should be observed closely to determine if the desired effect of the diuretic is obtained.

Irbesartan administration for 7 days had no effect on the pharmacokinetics of digoxin.

Irbesartan administration for 7 days had no effect on the pharmacokinetics of hydrochlorothiazide. Pharmacokinetics of irbesartan were not affected by coadministration.

In vitro studies suggest CYP 2C9 inhibition, but in clinical studies nifedipine showed no clinically significant effect on irbesartan pharmacokinetics or pharmacodynamics.

In clinical studies, concomitant irbesartan had negligible consequences on the pharmacodynamics of warfarin (prothrombin time).

Since desogestrel is mainly metabolized by the cytochrome P450 2C9 enzyme (CYP 2C9) to form etonogestrel, the active progestin, there is a possibility of interaction with CYP 2C9 substrates or inhibitors (such as: ibuprofen, piroxicam, naproxen, phenytoin, fluconazole, diclofenac, tolbutamide, glipizide, celecoxib, sulfamethoxazole, isoniazid, torsemide, irbesartan, losartan, and valsartan).

Table 3: No observed clinically important drug interactions of Veltassa Angiotensin-converting enzyme (ACE) inhibitors Benazepril, captopril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril, trandolapril Angiotensin II receptor blockers (ARB) Azilsartan, candesartan, irbesartan, losartan, olmesartan, valsartan β-adrenoceptor blockers (β-blocker) Metoprolol Loop diuretics Furosemide, bumetanide, torasemide Mineralocorticoid receptor antagonists (MRA) Eplerenone, finerenone, spironolactone Neprilysin inhibitors Sacubitril Sodium-glucose cotransporter-2 (SGLT-2) inhibitors Canagliflozin, dapagliflozin, empagliflozin Antibiotics Trimethoprim, amoxicillin, cephalexin Anticoagulants Warfarin, apixaban, rivaroxaban Anti-parathyroid agents and Thyroid preparations Cinacalcet Antithrombotic agents Clopidogrel, acetylsalicylic acid Blood glucose lowering drugs Glipizide Calcium channel blockers Amlodipine, verapamil Immunosuppressants Tacrolimus Others Lithium, allopurinol, atorvastatin, digoxin, phenytoin, riboflavin, sevelamer

In vitro studies show significant inhibition of the formation of oxidized irbesartan metabolites with the known cytochrome CYP 2C9 substrates/inhibitors sulphenazole, tolbutamide and nifedipine.

In vitro studies show significant inhibition of the formation of oxidized irbesartan metabolites with the known cytochrome CYP 2C9 substrates/inhibitors sulphenazole, tolbutamide and nifedipine.