Avapro (Irbesartan) – Uses, Dosing, Side Effects, Kidney Protection, and Safety Information

Avapro is a prescription medication that contains irbesartan. It belongs to a class of medications called angiotensin II receptor blockers, also known as ARBs. Avapro is used to treat high blood pressure and may also be used in certain patients with type 2 diabetes and kidney disease.

Avapro helps relax blood vessels so blood can flow more easily. This can lower blood pressure and reduce strain on the heart, kidneys, and blood vessels over time. For patients with type 2 diabetes and kidney involvement, irbesartan may help slow the progression of kidney disease when used as part of an overall treatment plan.

What Avapro Is Used For

Avapro is indicated for the treatment of:

• Essential hypertension, also known as high blood pressure
• Hypertensive patients with type 2 diabetes and renal disease, to reduce the rate of progression of nephropathy

Avapro may be used alone or with other blood pressure medications, including thiazide diuretics, depending on the patient’s blood pressure response and overall treatment plan.

How Avapro Works

Irbesartan blocks the action of angiotensin II at the AT1 receptor. Angiotensin II is a hormone that causes blood vessels to narrow and stimulates aldosterone secretion, which can contribute to higher blood pressure.

By blocking angiotensin II:

• Blood vessels relax
• Blood pressure decreases
• The heart does not need to work as hard
• Kidney pressure and protein-related kidney stress may be reduced in certain patients

Unlike ACE inhibitors, irbesartan does not inhibit angiotensin-converting enzyme and does not directly affect bradykinin breakdown. This is one reason ARBs may be considered in some patients who cannot tolerate ACE inhibitor-related cough, although treatment choice depends on the prescriber’s assessment.

Available Strengths

Avapro tablets are available in the following strengths:

• 75 mg tablets
• 150 mg tablets
• 300 mg tablets

The tablets are taken by mouth and may be taken with or without food.

Typical Avapro Dosing

Essential hypertension

• Recommended starting dose: 150 mg once daily
• If blood pressure is not adequately controlled, the dose may be increased to 300 mg once daily

Hypertension with type 2 diabetic kidney disease

• Recommended starting dose: 150 mg once daily
• If blood pressure is not adequately controlled, the dose may be increased to 300 mg once daily
• 300 mg once daily is the preferred maintenance dose for this indication

Patients on hemodialysis or volume-depleted patients

Some patients may be more sensitive to blood pressure lowering effects. An initial dose of 75 mg once daily may be recommended in hemodialysis patients or hypovolemic patients.

Older adults

No initial dosage adjustment is required solely based on age, although some older patients may be more sensitive to blood pressure medications.

How to Take Avapro

• Take Avapro exactly as prescribed.
• Take it once daily, at the same time each day.
• It may be taken with or without food.
• Do not stop taking it unless your healthcare provider tells you to.
• Continue lifestyle measures such as diet, exercise, and salt restriction if recommended.

Blood pressure medications often need to be taken long term, even when symptoms are not noticeable. High blood pressure can silently increase the risk of stroke, heart attack, kidney disease, and other complications.

Missed Dose

• If you miss a dose, take your next dose at the regular scheduled time.
• Do not take two doses at the same time.

Common Side Effects

Avapro is generally well tolerated, but side effects can occur.

Side effects reported in clinical studies included:

• Headache
• Dizziness
• Fatigue
• Diarrhea
• Nausea or vomiting
• Dyspepsia or heartburn
• Musculoskeletal pain
• Chest pain
• Abdominal pain
• Edema or swelling
• Cough
• Rash

In placebo-controlled hypertension trials, dizziness and headache were reported, but headache was actually more common in placebo-treated patients than in Avapro-treated patients.

Serious Side Effects and Warnings

Pregnancy warning

Avapro should not be used during pregnancy. Drugs that act on the renin-angiotensin-aldosterone system can cause injury or death to a developing fetus. If pregnancy is detected, Avapro should be stopped as soon as possible and the patient should contact their healthcare provider right away.

Low blood pressure

Symptomatic low blood pressure may occur, especially after the first dose in patients who are volume depleted. This may include patients taking diuretics, following strict salt restriction, undergoing dialysis, or experiencing diarrhea or vomiting.

Symptoms may include dizziness, light-headedness, weakness, or fainting.

Kidney function changes

Because Avapro affects the renin-angiotensin-aldosterone system, kidney function changes may occur in susceptible patients. This is more likely in patients with renal artery stenosis, severe congestive heart failure, kidney impairment, or those taking other medications that affect kidney function.

Kidney function should be assessed as appropriate during treatment.

High potassium

Avapro may increase potassium levels, especially in patients with kidney disease, diabetes, or those taking potassium supplements, potassium-sparing diuretics, salt substitutes containing potassium, or other medications that raise potassium.

Symptoms of high potassium can include weakness, irregular heartbeat, or palpitations, although some patients have no symptoms and only discover it through blood work.

Angioedema and allergic reactions

Rare post-market reports have included angioedema involving swelling of the face, lips, and/or tongue. Seek urgent medical attention if swelling, trouble breathing, or symptoms of a serious allergic reaction occur.

Psoriasis warning

Avapro may exacerbate psoriasis in some patients. Patients with psoriasis or a history of psoriasis should discuss this with their healthcare provider before starting treatment.

Who Should Not Use Avapro?

Avapro should not be used in patients who:

• Are allergic to irbesartan or any ingredient in the tablet
• Are pregnant
• Are breastfeeding
• Are taking aliskiren-containing drugs and have diabetes or moderate to severe kidney impairment
• Are taking an ACE inhibitor and have diabetic nephropathy
• Have rare hereditary problems of galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption because Avapro tablets contain lactose

Drug Interactions

Patients should tell their healthcare provider about all prescription medications, over-the-counter drugs, vitamins, and supplements they take.

Important interaction considerations include:

• Potassium supplements, potassium-sparing diuretics, or potassium-containing salt substitutes may increase potassium levels.
• Diuretics may increase the risk of low blood pressure when starting Avapro.
• Aliskiren-containing drugs may increase the risk of low blood pressure, fainting, stroke, high potassium, and kidney problems in certain patients.
• ACE inhibitors should not be combined with Avapro in patients with diabetic nephropathy.
• Lithium levels and lithium toxicity may increase when used with irbesartan.
• NSAIDs, including COX-2 inhibitors, may reduce the blood pressure-lowering effect and may worsen kidney function in susceptible patients.
• Antidiabetic medications, including insulin and oral diabetes medications, may require monitoring because irbesartan may contribute to hypoglycemia in some patients.

Avapro and Diabetes-Related Kidney Disease

Avapro has an important role in certain hypertensive patients with type 2 diabetes and kidney disease. In this population, irbesartan has been studied for reducing the progression of nephropathy, including markers such as microalbuminuria and doubling of serum creatinine.

This does not mean Avapro is appropriate for every patient with diabetes. The decision depends on blood pressure, kidney function, potassium levels, protein in the urine, other medications, and the patient’s overall cardiovascular and kidney risk.

How Avapro Compares to Other Blood Pressure Medications

Avapro is an ARB, which means it is in the same general class as medications such as valsartan, losartan, candesartan, olmesartan, and telmisartan.

Compared with ACE inhibitors, ARBs block the angiotensin II receptor rather than inhibiting ACE. Both classes affect the renin-angiotensin system, but they differ in mechanism, side effect profile, and interaction considerations.

• ACE inhibitors may be more associated with dry cough in some patients.
• ARBs such as Avapro may be used when an ARB is preferred by the prescriber.
• Both ACE inhibitors and ARBs can increase potassium and affect kidney function.
• Combining an ACE inhibitor with an ARB is generally not recommended and is contraindicated in certain patients.

Blood Pressure Monitoring

Patients taking Avapro should monitor blood pressure as directed by their healthcare provider. It may take 1 to 2 weeks to see a substantial blood pressure-lowering effect, with the maximum effect generally occurring within 4 to 6 weeks.

Patients should also complete recommended lab monitoring when advised, especially if they have kidney disease, diabetes, are taking potassium-altering medications, or are using NSAIDs regularly.

Buying Avapro from Canada

Avapro may be used long term for blood pressure control and kidney protection in appropriate patients. Because long-term cardiovascular medications can become expensive in the United States, many Americans compare Canadian pricing for brand name and generic blood pressure medications.

Over The Border Meds is a Canadian prescription referral service that helps eligible U.S. patients access medications from Canada with a valid prescription. For Avapro, it is helpful to confirm:

• The prescribed strength: 75 mg, 150 mg, or 300 mg
• The daily dosing schedule
• Whether it is being used for high blood pressure, diabetic kidney disease, or both
• Whether the patient takes diuretics, potassium supplements, NSAIDs, lithium, aliskiren, or ACE inhibitors
• Whether kidney function and potassium levels are being monitored

Learn more: Over The Border Meds

Storage

• Store Avapro at room temperature between 15°C and 30°C.
• Keep tablets in their original container.
• Keep out of reach of children.
• Do not use past the expiry date.

Disclaimer

This information is for educational purposes only and does not replace medical advice. Avapro should be used only as prescribed. Speak with your healthcare provider before starting, stopping, or changing blood pressure medication. Seek urgent medical attention for symptoms of severe allergic reaction, fainting, severe dizziness, or pregnancy while taking Avapro.

Reference: Avapro Product Monograph (Canada)