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
Irbesartan
Angiotensin II receptor blocker (ARB) · Antihypertensive
START
150 mg PO once daily (75 mg if elderly/volume-depleted); nephropathy target 300 mg/day
TYPICAL MAX
300 mg/day
STOP IF
Pregnancy, angioedema, K+ >6.0, AKI (creatinine rise >30%)
WATCH
BP, K+ and creatinine 1–2 weeks after start/titration, pregnancy status
CDSCO approvedSchedule HATC C09CA04
KDIGO 2024 + manufacturer label
- ONSET
- 2h · BP onset
- PEAK
- 2h · Cmax
- t½
- 13h · plasma t½
- DURATION
- 1d · once-daily effect
EXCRETION
~80% biliary/faecal, ~20% renal; minimal metabolism
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Contraindicated 2nd/3rd trimester — fetal renal/skull injury, death; discontinue if pregnancy detected
FDA category + note
Top interactionssee all 12 →
- Sacubitril ValsartanContraindicatedTextbookG&G 14e · p602
- AliskirenContraindicatedDatabaseKimi deep-research + Cla
- Angiotensin Converting Enzyme InhibitorsSevereTextbookHarrison 22e · p2396
- EnalaprilatSevereTextbookG&G 14e
Available in India
21 branded formulations and 6 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Mechanism
Selective AT1-receptor antagonist blocking angiotensin II vasoconstriction and aldosterone release → reduced BP, afterload and intraglomerular pressure (renoprotection in diabetic nephropathy).
Indications
HypertensionDiabetic nephropathy in type 2 diabetes with hypertension (renoprotection)
Dosing
- Adult
- 150 mg PO once daily (start 75 mg if volume-depleted/elderly), titrate to 300 mg/day. Diabetic nephropathy target 300 mg/day.
- Pediatric
- 6–12 y: 75–150 mg/day; ≥13 y up to 300 mg/day (specialist).
- Renal adjustment
- No initial adjustment; monitor K+/creatinine.
- Hepatic adjustment
- No adjustment in mild–moderate; caution in severe.
- Geriatric
- No specific adjustment; consider 75 mg start.
- Max dose
- 300 mg/day
Pharmacokinetics
Onset
~2 h (BP); full effect 2–4 weeks
Peak effect
1.5–2 h Cmax
Duration
>24 h
Half-life
~11–15 h
Bioavailability
~60–80% (food-independent)
Protein binding
~90%
Metabolism
Hepatic CYP2C9 (minor) + glucuronidation; mostly unchanged
Excretion
Biliary/faecal (~80%) and renal (~20%)
Contraindications
- Pregnancy (2nd/3rd trimester)
- Bilateral renal artery stenosis
- Concomitant aliskiren in diabetes
- Hypersensitivity/angioedema with ARB
Side effects
Common
DizzinessHyperkalaemia (with renal impairment/K-sparing)FatigueOrthostatic hypotension (volume-depleted)
Serious
- Angioedema
- Acute kidney injury (RAS/volume depletion)
- Severe hyperkalaemia
- Fetal toxicity (2nd/3rd trimester)
Pregnancy & lactation
Pregnancy
Contraindicated 2nd/3rd trimester — fetal renal/skull injury, death; discontinue if pregnancy detected
Lactation
Avoid — alternatives preferred (limited data)
Drug interactions
Aliskiren
Contraindicated
Database
Dual RAAS blockade → hyperkalaemia/AKI/hypotension
Do not combine in diabetes or eGFR <60
Source: Kimi deep-research + Cla
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
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
Lithium
Severe
Database
Reduced lithium clearance → toxicity
Monitor lithium levels
Source: Kimi deep-research + Cla · p378
Related guidelines
Other Angiotensin II receptor blocker (ARB) drugs
Ask House about Irbesartan
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19