Sacubitril Valsartan
Contraindicated
Textbook
Potentially excessive hypotension, increased risk of adverse effects.
Do not use in conjunction with other ARBs.
Source: G&G 14e · p602
Drug reference
Azilsartan medoxomil
ARB · Antihypertensive
Also known as Edarbi
ARBAntihypertensive
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
11 major
incl. contraindicated
PREGNANCY
Avoid in pregnancy unless essential. May adversely affect fetal and neonatal blood pressure control and renal function; neonatal skull defects and oligohydramnios have been reported.
FDA category + note
Top interactionssee all 11 →
- Sacubitril ValsartanContraindicatedTextbookG&G 14e · p602
- Angiotensin Converting Enzyme InhibitorsSevereTextbookHarrison 22e · p2396
- EnalaprilatSevereTextbookG&G 14e
- ImidaprilSevereTextbookHarrison 22e · p2396
Mechanism
Azilsartan medoxomil, a prodrug, is hydrolyzed to azilsartan, which selectively blocks the AT1 receptor, preventing angiotensin II from binding. This action inhibits various effects mediated by angiotensin II, including vasoconstriction, aldosterone secretion, rapid and slow pressor responses, and cellular hypertrophy, thereby reducing blood pressure.
Indications
HypertensionHypertension with intravascular volume depletionHeart failure
Dosing
- Adult
- Hypertension (18–74 years): Initially 40 mg once daily, increased if necessary to 80 mg once daily. Hypertension with intravascular volume depletion: Initially 20–40 mg daily, increased if necessary to 80 mg daily.
- Renal adjustment
- Use with caution, starting with low dose, and adjust according to response. Manufacturer advises caution in severe impairment.
- Hepatic adjustment
- Consider initial dose of 20 mg in mild to moderate impairment; monitor closely. Avoid in severe impairment.
- Geriatric
- Adult 75 years and over (Hypertension): Initially 20–40 mg once daily, increased if necessary to 80 mg once daily. Monitor plasma-potassium concentration.
- Max dose
- 80 mg once daily
Contraindications
- Hyperkalaemia (plasma-potassium concentration > 5.0 mmol/litre)
- Hypotension (systolic blood pressure below 90 mmHg)
- Unstable heart failure
- Pregnancy
- Severe hepatic impairment
- Concomitant use with ACE inhibitors or aliskiren
Side effects
Common
Abdominal painAstheniaBack painCoughDiarrhoeaDizzinessHeadacheHyperkalaemiaHypotensionPostural hypotensionRenal impairmentVertigoVomitingHyperuricaemiaMuscle spasmsPeripheral oedema
Serious
- Angioedema
- Myalgia
- Skin reactions
- Thrombocytopenia
- Arthralgia
- Hepatic function abnormal
Pregnancy & lactation
Pregnancy
Avoid in pregnancy unless essential. May adversely affect fetal and neonatal blood pressure control and renal function; neonatal skull defects and oligohydramnios have been reported.
Lactation
Information on the use in breast-feeding is limited. Not recommended in breast-feeding; alternative treatment options with better established safety information are available.
Drug interactions
Angiotensin Converting Enzyme Inhibitors
Severe
Textbook
Greater incidence of acute kidney injury (AKI) and adverse cardiac events.
The combination of these two classes should be avoided.
Source: Harrison 22e · p2396
Enalaprilat
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Imidapril
Severe
Textbook
Greater incidence of acute kidney injury (AKI) and adverse cardiac events.
The combination of these two classes should be avoided.
Source: Harrison 22e · p2396
Aliskiren
Severe
Database
Increased risk of hypotension, hyperkalemia, and renal impairment.
Avoid concomitant use.
Source: DDInter
Amiloride
Severe
Database
Hyperkalemia.
Monitor K+ levels.
Source: DDInter
Benazepril
Severe
Database
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: DDInter
Captopril
Severe
Database
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: DDInter
Enalapril
Severe
Database
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: DDInter
Fosinopril
Severe
Database
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: DDInter
Lisinopril
Severe
Database
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: DDInter
1 additional unreviewed or low-confidence interaction hidden because their provenance or source detail is insufficient.
Related guidelines
Other ARB drugs
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Textbook-sourced·Sources: BNF·Updated: 2026-05-10