BLACK BOX WARNING
- fetal toxicity
irbesartan
Brand: Avapro
⚠ BBW Prototype: losartan
Drug Class: angiotensin II receptor blocker (ARB)
Drug Family: antihypertensive
Subclass: AT1 receptor antagonist
Organ Systems: cardiovascularrenal
Mechanism of Action
Non-competitive (insurmountable) AT1 receptor antagonist; reduces angiotensin II effects.
AT1 receptor
Indications
- hypertension
- diabetic nephropathy in type 2 diabetes with hypertension
Contraindications
- pregnancy
- aliskiren in DM
Adverse Effects
Common
- dizziness
- hyperkalemia
- upper respiratory infection
Serious
- AKI
- teratogenicity
Pharmacokinetics (ADME)
| Absorption | 60-80% oral bioavailability |
| Distribution | high lipophilicity |
| Metabolism | hepatic CYP2C9 |
| Excretion | fecal 80%, renal 20% |
| Half-life | 11-15 hours |
| Onset | 1-2 hours |
| Peak | 3-6 hours |
| Duration | 24 hours |
| Protein Binding | 90% |
| Vd | 53-93 L |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| potassium-sparing diuretics | additive hyperkalemia | major |
| fluconazole | CYP2C9 inhibition increases irbesartan levels | moderate |
Nursing Considerations
- FDA-approved for diabetic nephropathy in T2DM
- Monitor BP, K+, renal function
- Non-competitive AT1 block means high doses of angiotensin II cannot overcome blockade
Clinical Pearls
- IDNT trial: reduced progression of diabetic nephropathy independent of BP
- Non-competitive binding distinguishes from losartan
Safety Profile
Pregnancy contraindicated
Lactation avoid
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.