Drug reference

Azilsartan medoxomil

ARB · Antihypertensive

Also known as Edarbi

ARBAntihypertensive

CDSCO approved

EXCRETION

—

not curated

INTERACTIONS

12 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 12 →

Sacubitril ValsartanContraindicatedTextbookG&G 14e · p602
Dual Blockade Of The Renin Angiotensin Aldosterone System (raas) With Direct Renin Inhibitors (e.g., Aliskiren)ContraindicatedDatabase
Angiotensin Converting Enzyme InhibitorsSevereTextbookHarrison 22e · p2396
EnalaprilatSevereTextbookG&G 14e

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

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

Dual Blockade Of The Renin Angiotensin Aldosterone System (raas) With Direct Renin Inhibitors (e.g., Aliskiren)

Contraindicated

Database

Increased risk of hypotension, hyperkalemia, and renal function impairment (including acute renal failure). This combination is contraindicated in patients with diabetes mellitus or renal impairment (GFR < 60 mL/min/1.73 m²).

Contraindicated in patients with diabetes mellitus or renal impairment (GFR < 60 mL/min/1.73 m²). Avoid in all other patients.

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

Dual Blockade Of The Renin Angiotensin Aldosterone System (raas) With Ace Inhibitors (e.g., Ramipril, Enalapril)

Severe

Database

Increased risk of hypotension, hyperkalemia, and renal function impairment (including acute renal failure) compared to monotherapy.

Concomitant use is generally not recommended, especially in patients with diabetic nephropathy. If deemed absolutely necessary, use under specialist supervision with close monitoring of blood pressure, renal function, and electrolytes.

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