Azilsartan

What is Azilsartan?

Azilsartan is an oral medication that belongs to a class of drugs called angiotensin receptor blockers (ARBs). It is primarily prescribed to treat high blood pressure (hypertension) in adults by helping blood vessels relax and widen. This medication is often used when other blood pressure medications have not been effective or have caused unacceptable side effects.

Uses

• Hypertension: Primary indication for treating high blood pressure in adults, helping to reduce cardiovascular risk
• Cardiovascular protection: May help reduce the risk of heart attack and stroke in patients with hypertension
• Kidney protection: Can help protect kidney function in diabetic patients with high blood pressure
• Heart failure management: Sometimes used as part of combination therapy for certain heart failure patients
• Diabetic nephropathy: May slow progression of kidney disease in diabetic patients with protein in their urine

How it works

Azilsartan blocks the action of angiotensin II, a hormone that causes blood vessels to narrow and constrict. By preventing angiotensin II from binding to its receptors in blood vessel walls, azilsartan allows vessels to remain relaxed and dilated. This reduction in blood vessel resistance leads to lower blood pressure and improved blood flow throughout the body.

Side effects

Common side effects:

• Dizziness or lightheadedness
• Fatigue or weakness
• Diarrhea
• Headache
• Nausea
• Cough
• Back pain
• Muscle cramps

Serious side effects to watch for:

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• Severe dizziness or fainting
• Signs of kidney problems (changes in urination, swelling)
• Hyperkalemia (high potassium levels)
• Severe allergic reactions (difficulty breathing, swelling of face or throat)
• Liver problems (yellowing of skin or eyes, dark urine)

Warnings and precautions

• Pregnancy: Should not be used during pregnancy, especially in the second and third trimesters, as it can cause serious harm to the developing fetus including kidney problems and death
• Kidney disease: Requires careful monitoring and possible dose adjustment in patients with existing kidney impairment or kidney artery stenosis
• Liver disease: Use with caution in patients with liver problems, as the drug is processed through the liver
• Dehydration: Patients who are volume-depleted or dehydrated may experience severe blood pressure drops when starting treatment
• Elderly patients: May be more sensitive to blood pressure-lowering effects and require lower starting doses

Interactions

• Potassium supplements and salt substitutes: May increase potassium levels to dangerous amounts when combined with azilsartan
• Diuretics: Can enhance blood pressure-lowering effects, potentially causing excessive drops in blood pressure
• NSAIDs (ibuprofen, naproxen): May reduce the effectiveness of azilsartan and increase kidney damage risk
• Lithium: Azilsartan may increase lithium levels in the blood, leading to toxicity
• ACE inhibitors: Combining with azilsartan may increase risk of kidney problems and high potassium
• Aliskiren: Should not be used together in diabetic patients due to increased risk of kidney problems and high potassium
• Warfarin: May require monitoring of blood clotting times as effects could be altered
• Digoxin: Azilsartan may slightly increase digoxin levels requiring monitoring

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Dosage

The typical starting dose for adults is 40 mg once daily, which can be increased to a maximum of 80 mg once daily if needed for blood pressure control. The medication can be taken with or without food at the same time each day. Patients with kidney impairment may require lower starting doses. For elderly patients or those taking high-dose diuretics, a lower starting dose of 20 mg once daily may be considered. All dosage adjustments should be made gradually and under medical supervision, as individual response to treatment varies significantly.

Sources: FDA DailyMed drug labels (public domain), BNF, WHO Essential Medicines List. This article is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider before starting or stopping any medication.

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