Aprovel tablets: instructions for use and price

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

Angiotensin II receptor antagonist. Causes an increase in renin and angiotensin II in the blood and a decrease in the concentration of aldosterone . The concentration of potassium in the blood does not change. Dose-dependently reduces blood pressure, but when used above 900 mg/day, the increase in hypotensive effect is insignificant. A decrease in blood pressure is observed after 3–6 hours, the effect persists for 24 hours. The hypotensive effect increases over 1–2 weeks, and the maximum is detected after 1–1.5 months. Efficiency does not depend on gender. The drug does not affect the level of uric acid in the blood. There is no withdrawal syndrome noted.

Irbesartan does not affect renal function in patients with diabetic nephropathy , glomerulonephritis , and therefore is the drug of choice in these patients.

Pharmacokinetics

Well absorbed, bioavailability 60-80%. The maximum concentration is determined in the blood after 1.5-2 hours, equilibrium - after 3 days. 96% protein bound.

Metabolized by the cytochrome P450 CYP2C9 system of the liver. Excreted by the liver and kidneys. T1/2 is 11–14 hours. For patients with impaired function of these organs, as well as for elderly people, no dose adjustment is performed.

Cardiovascular disease is a leading cause of death and disability. One of the first places among cardiovascular pathologies belongs to arterial hypertension (AH), which currently causes 5.8% of all deaths. About 50 million, or 20%, of adults in the United States have hypertension, defined as a mean systolic blood pressure (SBP) ≥ 140 mmHg. Art., mean diastolic pressure (DBP) ≥ 90 mm Hg. Art. or the need for continuous use of antihypertensive drugs. The course of the disease is not controlled in 40–70% of patients of various ages [1].

Hypertension is the main cause of target organ damage: the heart, brain and kidneys. Characteristic attributes of hypertension are diseases such as heart and kidney failure, myocardial infarction, stroke and dissecting aortic aneurysm [4]. According to the American Heart Association (AHA), hypertension is one of the main risk factors for stroke, the incidence of which has increased by approximately 10% in the United States over the past 3 years. To prevent this trend from accelerating further, the AHA is pushing for increased oversight of hypertension treatment.

Unfortunately, modern antihypertensive therapy, despite its proven effect on mortality from hypertension, only provides effective blood pressure control in some patients. It is believed that among patients receiving drug treatment, normalization of blood pressure (SBP)

Accurate compliance by patients with medical prescriptions and their adherence to treatment are mandatory conditions for achieving hypertension control [2]. In addition, these factors affect the cost of treatment. The varying side effect profile of modern antihypertensive agents, such as diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers, may limit patient adherence to treatment and, consequently, the overall effectiveness of therapy. It has been shown that the likelihood of a patient discontinuing treatment is determined by the drug prescribed for initial therapy, likely reflecting varying tolerability of antihypertensive agents. An analysis of more than 3 million prescriptions of antihypertensive drugs demonstrated that only 26% of patients who began treatment with ACE inhibitors continued to take them at the 5th year of treatment, and for calcium channel blockers, diuretics and beta-blockers this figure was even lower (20, 19 and 16% respectively). It follows from this that an extremely important goal of therapy is to achieve the most accurate compliance by patients with medical prescriptions due to a favorable efficiency/tolerability ratio of treatment, which undoubtedly affects the control of the course of the disease as a whole.

In recent years, health authorities in many countries have been concerned about the widespread prevalence of diabetes mellitus (DM), especially type 2, which accounts for 97% of all DM cases. If in 2000 there were 115 million people with type 2 diabetes worldwide, by 2025 their number is projected to reach 300 million [3, 4]. It is known that diabetes can lead to the development of coronary artery disease, lesions of peripheral arteries, gangrene of the lower extremities, stroke, diabetic retinopathy, diabetic nephropathy with the possible development of renal failure, etc. In Russia, approximately 4.2 people suffer from diabetes, according to the Russian Endocrinology Center. % of the population.

It is known that 39% of patients with hypertension have type 2 diabetes, and, on the contrary, 71% of patients with type 2 diabetes have hypertension. It has also been established that 30–75% of diabetes complications are associated with hypertension. Type 2 diabetes is one of the main causes of the development of renal disorders, which, according to US experts, are detected in 43% of newly diagnosed patients. Approximately 10–40% of patients with type 2 diabetes subsequently develop chronic kidney disease, often requiring hemodialysis.

Irbesartan is an angiotensin II (AII) receptor blocker and is characterized by high selectivity and irreversible blockade of AT1 receptors, and its efficacy and tolerability profile helps to increase patient adherence to treatment. The effectiveness of irbesartan increases with increasing dose, while tolerability remains the same across different dosages as for placebo. Irbesartan (Aprovel) was developed at the Sanofi research center. This drug has been extensively studied in clinical studies.

Irbesartan lowers blood pressure by blocking the renin-angiotensin system (RAS) at the level of AII receptors. The RAS is a key regulator of blood pressure and sodium homeostasis. The effects of RAS are realized both at the cellular and organ levels through various physiological and pathophysiological mechanisms.

The function of the RAS is determined by a cascade of substrate-enzyme interactions, starting with the formation of angiotensin in the liver. Renin, secreted by the cells of the juxtaglomerular apparatus of the kidneys, converts angiotensinogen into angiotensin I (AI), an inactive decapeptide. Subsequently, ACE ensures the conversion of AI into the multifunctional peptide AII. Physiological effects of AII include increased blood pressure, vasoconstriction, stimulation of renal sodium reabsorption, release of aldosterone, negative feedback for the release of renin and vasopressin, stimulation of thirst, release of catecholamines from the adrenal glands and nerve endings, and release of prostaglandins. The RAS is also a mediator of metabolic, inotropic activity and myocardial hypertrophy processes. AII plays an important role in the pathophysiology of such clinical conditions as essential hypertension, renal hypertension, congestive heart failure, coronary insufficiency and various kidney diseases associated with albuminuria.

AII binds to receptors of the AT1 and AT2 subtypes. All known effects of AII that contribute to the development of hypertension are mediated through AT1 receptors. AT2 receptors have been found in fetal tissue, immature brain, skin wounds, and atretic ovarian follicles and are thought to be involved in growth and maturation. However, the physiological functions of these receptors remain unclear, in particular their role in the regulation of blood pressure is unknown. Recent studies performed on cell cultures have shown that activation of AT2 receptors under the influence of AII inhibits the growth of endothelial cells and smooth muscle cells of the vascular wall [6, 7].

Due to the fact that the RAS is likely involved in the development of hypertension and its complications, blocking the cascade reactions of this system has been the subject of many pharmacological studies. It turns out that adrenergic blockers can indirectly interrupt the cascade by inhibiting sympathetic stimulation of renin formation and release [15]. ACE inhibitors block the conversion of AI to AII. More complete blockade of the RAS can be achieved with either renin inhibitors or AII receptor blockers. Although renin inhibitors prevent AII synthesis, drugs with this mechanism of action have not yet been developed for clinical use due to their inadequate oral bioavailability.

ACE inhibition differs from AT1 receptor blockade in a number of important ways. Although high doses of ACE inhibitors suppress the conversion of AI to AII, there may be alternative pathways for this transformation. Unlike ACE inhibition, blockade of AT1 receptors completely suppresses the action of AII at the receptor level. Another important difference is determined by the effects of ACE inhibitors outside the RAS. ACE is identical to kinase II, the enzyme that degrades bradykinin, so ACE inhibitors, by blocking kinase II, promote the accumulation of bradykinin.

Blockade of kinase II, accumulation of bradykinin, neurotensin, met-enkephalin and substance P, observed with the use of ACE inhibitors [16], may be of great importance in the development of side effects such as cough and possibly angioedema. These side effects do not occur with complete blockade of AII action.

A study of the hypotensive effect of irbesartan in healthy male volunteers showed that a single dose of 150–300 mg of this drug provides complete blockade of the pressor action of AII 2–4 hours after administration; A 24-hour decrease in DBP after administration of 25–300 mg of irbesartan was observed in 30–70% of volunteers.

In randomized pharmacodynamic crossover studies in healthy volunteers, the blocking effect of equivalent doses of irbesartan, valsartan and losartan on DBP in the presence of exogenous angiotensin II was studied. The effect of irbesartan and valsartan was maximum after 4 hours, losartan - after 10 hours. The effect of irbersartan on DBP within 24 hours was significantly more pronounced than that of valsartan and losartan. With candesartan, irbesartan had approximately the same effect.

Changes in the time required to achieve a sustained reduction in blood pressure in patients with hypertension when taking irbesartan demonstrates the progression of the antihypertensive effect of the drug after the start of daily dosing. The hypotensive effect was observed within a few hours after taking the first dose of irbesartan, stabilized within 1–2 weeks and reached a maximum by 4–6 weeks of treatment. When taking the drug in doses of 150 and 300 mg once a day, the T/P ratio (the ratio of the residual hypotensive effect to the peak) for DBP was above 60%, which corresponds to a smooth 24-hour effect.

At a dose of 150 mg when taken once a day, irbesartan provided an optimal effect on blood pressure for 24 hours in an outpatient setting.

In an 8-week, double-blind study, the efficacy and safety of irbesartan administered orally at doses of 75 mg once daily, 150 mg once daily, and 75 mg twice daily were assessed using 24-hour ambulatory BP monitoring compared with placebo in patients with mild and moderate hypertension (DBP 95–110 mm Hg, with 24-hour monitoring > 85 mm Hg). The decrease in mean daily blood pressure was clinically and statistically significant in all three groups of patients. The same hypotensive effect was observed when irbesartan was prescribed in doses of 75 mg 2 times a day and 150 mg once a day, which indicates that there is no advantage when taking the drug twice a day. All three regimens for irbesartan were well tolerated by patients. At a dose of 150 mg once daily, the drug provided a clinically significant continuous reduction in blood pressure over 24 hours with the highest T/R ratio.

A meta-analysis of the results of 7 placebo-controlled studies of the effectiveness of irbesartan showed the same degree of reduction in SBP and DBP from baseline in men and women. Analysis of the effectiveness of the drug depending on age demonstrated identical values of the peak and residual effects of the drug in older and younger patients, which was confirmed in long-term open studies. The hypotensive effect of irbesartan manifested itself regardless of the race of the patients, although in black patients (low-renin population) it was somewhat less pronounced.

Irbesartan has a hypotensive effect in patients with any degree of hypertension. When analyzing the results of placebo-controlled studies, patients with hypertension were divided into 2 groups: with mild or moderate or severe hypertension, depending on the initial DBP (

It has been shown that irbesartan provides effective control of blood pressure in patients with hypertension and in the presence of renal failure. In an open, uncontrolled study, hypertensive patients with impaired renal function were divided into groups depending on the degree of renal failure: moderate, severe (creatinine clearance 30–60 ml/min and

In a number of randomized studies, the antihypertensive effect of irbesartan in patients with mild and moderate hypertension (DBP 95–110 mm Hg) was compared with the effect of atenolol, enalapril and amlodipine. The studies did not differ in the number of patients (about 100 in each treatment group), the distribution of patients by gender, age, race, or severity of hypertension. Decrease in blood pressure compared to baseline and the proportion of patients with normalization of blood pressure during treatment with irbesartan (DBP

In a 24-week double-blind study, treatment with irbesartan (75 mg/day with dose titration to 150 mg/day) provided a hypotensive effect comparable to that of atenolol (50 mg/day with dose titration to 100 mg/day), but the number of patients those who responded to irbesartan therapy by week 12 of treatment were higher (72 and 63%, respectively). Heart rate did not change in the group of patients receiving irbesartan, but, as expected, decreased in the atenolol group. The study showed that irbesartan, at least not inferior to atenolol in terms of hypotensive effect, was superior to it in terms of tolerability.

Another study compared irbesartan (75 mg/day with possible dose titration to 150–300 mg/day) with the ACE inhibitor enalapril, used in the full therapeutic dose range (10 mg/day with dose titration to 20–40 mg/day). Both drugs significantly reduced blood pressure without significant differences in effectiveness. Proportion of patients in whom it was possible to achieve normalization of blood pressure (DBP)

Another study compared irbesartan with enalapril in patients with severe hypertension (initial DBP 115–130 mmHg). The results of blood pressure measurements at week 12 of treatment showed that the administration of irbesartan (150 mg/day with possible dose titration to 300 mg/day) followed by the addition of hydrochlorothiazide and then atenolol and/or nifedipine to therapy was comparable in effectiveness to enalapril (20–40 mg/day) in combination with the same additional drugs. In both groups, blood pressure decreased by 40/30 mm Hg. Art. at the end of the interdose interval and at 45/36 mm Hg. Art. at the peak of action (3 hours after administration). At week 12, blood pressure normalized in 59% of patients receiving irbesartan and in 57% in the enalapril group. In patients who completed the 12th week of the study, blood pressure normalized more quickly when treated with irbesartan. On the other hand, patients receiving enalapril more often required 3 or more drugs. The incidence of cough as a side effect of therapy was significantly higher in the enalapril group (13 vs. 2%; p

In a randomized placebo-controlled trial, irbesartan at a dose of 300 mg was superior in antihypertensive efficacy to losartan at a dose of 100 mg. After 8 weeks of therapy, irbesartan 300 mg, irbesartan 150 mg and losartan 100 mg reduced DBP by 11.6; 9.7 and 8 mm Hg. Art. from the initial level, respectively. The differences between the hypotensive effects of irbesartan 300 mg and losartan 100 mg were significant starting from 1 week of treatment. The decrease in SBP by the 8th week of therapy when using irbesartan 300 mg was also more pronounced. By this time, 63, 60 and 56% of patients responded to treatment with irbesartan in doses of 300 and 150 mg and losartan in a dose of 100 mg, respectively [10]. Both drugs were well tolerated. The incidence of side effects and drug discontinuation due to side effects was comparable with losartan (57 and 3.6%) and placebo (53 and 3.4%). These phenomena occurred less frequently during treatment with irbesartan: the incidence of side effects when using this drug at a dose of 300 mg and its withdrawal was 44 and 1.4%, respectively.

Irbesartan demonstrated comparable efficacy to amlodipine in a pilot study in patients with type 2 diabetes with diabetic nephropathy and hypertension (SBP ≥ 135 mm Hg, DBP ≥ 85 mm Hg). In this 12-week randomized study, irbesartan was prescribed at a daily dose of 75–300 mg once daily to 24 patients, amlodipine at a daily dose of 2.5–10 mg once daily to 23 patients (initial doses could be doubled at 4 and 8 weeks ). Clinical characteristics of patients in both groups, including duration of diabetes, were identical.

Both treatments resulted in comparable reductions in DBP at the respective time points, although the mean reduction in SBP was slightly greater with amlodipine. Irbesartan reduced urinary protein excretion by 8.5% of baseline values, while amlodipine increased this figure by 19.7%. Despite the similar hypotensive effect of the drugs, creatinine clearance increased when using irbesartan, and decreased when using amlodipine. The difference in changes in creatinine clearance during treatment with irbesartan and amlodipine was statistically significant (p

It has been established that in half of patients with type 2 diabetes, proteinuria is detected 5–10 years after the onset of the disease. In addition, it is known that in developed countries, patients with severe renal failure undergo regular hemodialysis in 2/3 of cases, and every third patient undergoes a kidney transplant. Thus, the cost burden for the government due to kidney failure is enormous. Thus, in the USA, 15 billion dollars are spent annually on the treatment of severe renal failure, including 59 thousand per patient with type 2 diabetes. Mortality from renal failure caused by diabetic nephropathy is 1.5–2 times higher than Among patients without diabetes, only 20% of patients with diabetes and severe renal failure live more than 5 years from the start of hemodialysis [10]. All this makes the problem of preventing the development of new cases of type 2 diabetes and diabetic nephropathy extremely urgent. In recent years, the possibility of using RAS blockers—ACE inhibitors and AII antagonists—for this purpose, including in patients with hypertension, has been actively studied.

In the LIFE study [11], one year after the start of the use of losartan and atenolol in patients with hypertension, there were no differences in the incidence of new cases of type 2 diabetes, but by the end of the study (an average of 4.8 years), the risk of developing diabetes in the losartan group was lower. 25% lower than in the atenolol group (p

In the recently completed larger VALUE study [13], which included 15,245 hypertensive patients treated with valsartan or amlodipine, the risk of developing diabetes during treatment with an AII antagonist was 23% lower than with treatment with a calcium antagonist (p

In the small ALPINE study, patients with hypertension received candesartan in addition to felodipine or hydrochlorothiazide in combination with atenolol for a year. The number of cases of type 2 diabetes in the candesartan group at the end of the study was lower than in the hydrochlorothiazide group. Favorable changes in glucose and insulin levels were found with the use of candesartan.

Considering the renoprotective properties of irbesartan, Pohler et al. conducted a pilot study in which this drug was prescribed to patients with hypertension in combination with type 2 diabetes and diabetic nephropathy for 12 months. Irbesartan has been shown to reduce proteinuria by 9%. A larger, randomized, placebo-controlled trial using a similar protocol was performed as part of the PRIME program [13].

The IRMA-2 study (Irbesartan Microalbuminuria Type 2 Diabetic Study) included 590 patients suffering from hypertension and type 2 diabetes with the initial stage of renal damage (microalbuminuria 20–200 mg/min) and normal blood creatinine levels. About 400 patients received irbesartan 150 or 300 mg/day, 201 received placebo [14].

Irbesartan in both doses reduced SBP and DBP, and when used at a dose of 150 mg/day, additional antihypertensive drugs were prescribed to 45% of patients, and at a dose of 300 mg/day – to 43% of patients. In the placebo group, other antihypertensive agents (diuretics, beta-blockers, or calcium antagonists) were required in 56% of cases. Normalization of the rate of urinary excretion of albumin was observed in 21% of patients in the control group and 34% of patients receiving irbesartan at a dose of 300 mg/day. It should be noted that in one small study, irbesartan similarly reduced proteinuria in hypertensive or normotensive patients.

A continuation of the IRMA-2 study was the larger IDNT study (Irbesartan Diabetic Nephropathy Trial), which included 1714 patients with hypertension and type 2 diabetes who had proteinuria more than 900 mg/day and an increase in creatinine levels. Patients were randomized to receive irbesartan 300 mg/day, amlodipine 10 mg/day, or placebo. The average duration of follow-up for patients was 2.6 years.

The primary endpoints of the IDNT study were doubling of blood creatinine, development of end-stage renal disease requiring dialysis or kidney transplantation, and all deaths. In addition, the combined risk of fatal and nonfatal vascular events, including heart failure requiring hospitalization, stroke, and lower limb amputations, was assessed.

A doubling of creatinine levels when taking irbesartan was observed in 17% of patients, and in the amlodipine and placebo groups - in 25 and 24% of patients, respectively. Thus, the relative risk of achieving this endpoint in the irbesartan group was 33% (p = 0.003) and 37% (p

The risk of developing end-stage renal failure in the group of patients receiving irbesartan was 23% lower than when taking amlodipine and placebo. The average annual rate of change in glomerular filtration rate was the lowest with irbesartan use. A decrease in proteinuria was observed in 33% of patients receiving irbesartan, versus 6 and 10% in the amlodipine and placebo groups, respectively.

The combined incidence of cardiovascular complications in the irbesartan group was slightly lower than in the amlodipine and placebo groups.

Comparison of the data obtained in the IDNT study with the results of the RENAAL study [17], which was similar in design, which used losartan, allows us to compare the effectiveness of two AII receptor inhibitors. In particular, it was shown that, compared with the placebo group, the relative risk of doubling creatinine levels, developing end-stage renal failure or death was reduced with losartan by 16% (p = 0.02), and with irbesartan by 20% (p = 0.02). Separate analysis of outcomes showed that the risk of doubling creatinine levels was reduced by 25% (p = 0.005) when treated with losartan, and by 33% (p = 0.003) when treated with irbesartan. Large studies using irbesartan (Aprovel) to prevent kidney damage in hypertension and hypertension in combination with type 2 diabetes are currently ongoing or have just been completed, data on which are presented in the table. It is hoped that the results of these multicenter studies, the publication of which is expected in the near future, will add to the evidence base for the use of AII receptor antagonists to prevent kidney damage both in patients with isolated hypertension and in patients with a combination of hypertension and type 2 diabetes.

Indications for use

Aprovel is used for:

primary hypertension;
secondary hypertension;
kidney damage due to diabetes and other diseases.

It is prescribed with caution for hyponatremia , aortic valve stenosis , renal artery stenosis , coronary heart disease , severe liver and kidney failure .

Instructions for use of Aprovel (Method and dosage)

The tablet is taken orally without chewing. Treatment begins with 150 mg 1 time per day, this dose provides blood pressure control for 24 hours. If ineffective, the dose is increased to 300 mg.

For type II diabetes mellitus with arterial hypertension, 150 mg/day is initially prescribed and increased to 300 mg, since this dose is more preferable in the treatment of nephropathy . For persons over 75 years of age and patients on hemodialysis, the drug is prescribed at an initial dose of 75 mg. Prescribing a diuretic enhances the effect of the drug.

The drug Co Aprovel is a combination of Irbesartan + hydrochlorothiazide in dosages of 150 mg/12.5 mg and 300 mg/12.5 mg.

Instructions for use of Aprovel contain information that impaired renal and liver function in patients does not require dose adjustment.

Instructions for use APROVEL

Mechanism of action

When taken orally, irbesartan is an active selective antagonist of angiotensin II receptors (type AT1). It blocks all physiologically significant effects of angiotensin II through the AT1 receptor, regardless of the source or pathway of angiotensin II synthesis. The specific antagonistic effect on angiotensin II receptors (AT1) leads to an increase in the concentration of renin and angiotensin II and a decrease in the concentration of aldosterone in the blood plasma. When using the recommended doses of the drug, the concentration of potassium ion in the blood serum does not change significantly. Irbesartan does not inhibit kininase II. Irbesartan does not require metabolic activation to exert its effect.

Hypertension

Irbesartan dose-dependently (when used up to 900 mg/day) reduces blood pressure with minimal changes in heart rate.

The maximum reduction in blood pressure is achieved 3-6 hours after taking the drug orally, and the hypotensive effect persists for at least 24 hours. 24 hours after taking the recommended doses, the reduction in blood pressure is 50-70% compared to the maximum diastolic and systolic response HELL. When using the drug in a daily dose of 150-300 mg 24 hours after a single dose, the average decrease in blood pressure (in a lying or sitting position) is 8-13/5-8 mm Hg. (systolic/diastolic blood pressure) compared with placebo.

The hypotensive effect of the drug Aprovel develops within 1-2 weeks, and the maximum therapeutic effect is achieved 4-6 weeks after the start of treatment. The antihypertensive effect persists during long-term treatment. After cessation of treatment, blood pressure gradually returned to its original value; no withdrawal syndrome was observed.

The hypotensive effects of irbesartan and thiazide-type diuretics are additive. In patients who cannot control blood pressure with irbesartan monotherapy, the administration of small doses of hydrochlorothiazide (12.5 mg) leads to an additional reduction in blood pressure.

Irbesartan does not affect the level of uric acid in the blood serum or the excretion of uric acid in the urine.

Children and teenagers

Blood pressure lowering using planned titrated doses of irbesartan of 0.5 mg/kg (low), 1.5 mg/kg (moderate), and 4.5 mg/kg (high) was studied over 3 weeks in 318 pediatric and adolescent patients (6 to 16 years old) with hypertension or risk of developing it (diabetes, family history of hypertension). At the end of the 3-week period, the mean decrease from baseline in the primary effect variable, nadir steady-state systolic blood pressure (SBP), was 11.7 mmHg. (low dose), 9.3 mmHg (medium dose) and 13.2 mmHg. (high dose). No significant difference was observed between doses. The adjusted mean change in lowest steady-state diastolic blood pressure (LSBP) was as follows:

3.8 mmHg (low dose), 3.2 mmHg. (average dose) and 5.6 mm Hg. (high dose). During the subsequent 2-week period, in which patients were randomized to the active substance and placebo groups, in patients with placebo, the SDC and UDDC increased by 2.4 mmHg and 2.0 mmHg compared with +0.1 and -0.3 mm Hg, respectively, observed in patients receiving all indicated doses of irbesartan.

Hypertension and type 2 diabetes mellitus with kidney disease

The IDNT (Irbesartan for Diabetic Nephropathy) clinical trial showed that irbesartan slows the progression of kidney damage in patients with chronic renal failure and severe proteinuria. IDNT is a double-blind, controlled clinical morbidity and mortality study comparing Aprovel with amlodipine and placebo. In 1715 patients with type 2 diabetes mellitus with hypertension, proteinuria ≥900 mg/day and serum creatinine levels between 1.0 and 3.0 mg/dL, the long-term (mean 2.6 years) effect of Aprovel on the progression of kidney disease and mortality was studied. Doses were titrated from 75 mg to a maintenance dose of 300 mg, amlodipine doses from 2.5 mg to 10 mg, and placebo depending on individual tolerability. In all groups, patients received 2-4 antihypertensive drugs (eg, diuretics, beta-blockers, alpha-blockers) to achieve a pre-specified, desired blood pressure ≥135/85 mmHg. or a decrease in systolic pressure by 10 mm Hg, if the initial pressure was above 160 mm Hg. In the placebo group, sixty percent (60%) of patients achieved the required blood pressure level, and in the irbesartan and amlodipine groups - 76% and 78% of patients, respectively. Aprovel significantly reduced the relative risk of a two-fold increase in serum creatinine, end-stage renal disease, or mortality from any cause. Only about 33% of patients in the Aprovel group achieved the composite renal primary endpoint, compared with 39% and 41% in the placebo and amlodipine groups [20% relative risk reduction versus placebo (p=0.024) and 23% versus amlodipine (p= 0.006)].

When analyzing individual components of the primary endpoint, there was no effect on all-cause mortality, whereas there was a positive trend towards a reduction in end-stage renal disease and a significant reduction in the doubling of serum creatinine.

Therapeutic effect was assessed by subgroups based on sex, race, age, duration of diabetes, baseline blood pressure, serum creatinine level, and albumin excretion rate. In the subgroups of female and black patients, representing 32% and 26% of the total study population, a renoprotective effect was not obvious, although, judging by the confidence intervals, it is not excluded. Regarding the secondary endpoint (fatal and non-fatal cardiovascular changes), there were no differences between the three groups in the general population, although in the irbesartan group there was an increase in non-fatal myocardial infarction in women and a decrease in non-fatal myocardial infarction in men, compared with the therapeutic regimen , based on placebo. An increased incidence of non-fatal myocardial infarction and stroke was observed in women taking irbesartan when compared with a regimen that included amlodipine, while the incidence of hospitalization for heart failure decreased in the general population. However, no proper explanation was found for these phenomena observed in women.

The IRMA 2 trial (“Effect of irbesartan on microalbuminuria in hypertensive patients with type 2 diabetes mellitus”) showed that in patients with microalbuminuria, taking Aprovel at a daily dose of 300 mg slows down the transition of microalbuminuria to severe proteinuria. IRMA 2 was a double-blind, placebo-controlled clinical trial conducted in 590 patients with type 2 diabetes mellitus with microalbuminuria (30-300 mg/day) and normal renal function (serum creatinine ≤1.5 mg/dL in men and <1.1 mg /dl in women). The study examined the long-term (2 years) effects of Aprovel on progression to clinical (severe) proteinuria (urinary albumin excretion rate (UAMR) >300 mg/day and an increase in VAAM by at least 30% compared to baseline). Desired blood pressure was ≥135/85 mmHg. To achieve the desired blood pressure, additional antihypertensive drugs were used, if necessary (with the exception of ACE inhibitors, angiotensin II receptor antagonists and dihydropyridine calcium channel blockers). Although similar blood pressure levels were achieved in all treatment groups, fewer patients developed severe proteinuria in the Aprovel 300 mg group (5.2%) than in the placebo group (14.9%) and in the Aprovel 150 mg group (9.7%). demonstrating a 70% reduction in relative risk (at the higher (300 mg) daily dose) compared with placebo (p=0.0004). During the first three months of treatment, no simultaneous improvement in glomerular filtration rate (GFR) was observed. Slowing of the progression of clinical proteinuria was evident after three months and was maintained for 2 years. Recovery of renal function to the level of normoalbuminuria (<30 mg/day) was observed more often in the 300 mg Aprovel group (34%) than in the placebo group (21%).

Preclinical safety data

There were no signs of systemic or organ toxicity at clinically relevant doses. In preclinical safety studies, high doses of irbesartan (≥250 mg/kg/day for rats and ≥100 mg/kg/day for macaques) resulted in deterioration of red blood cell parameters (number, hemoglobin, hematocrit).

At very high doses (≥500 mg/kg/day), irbesartan caused degenerative changes in the kidneys of rats and macaques (such as interstitial nephritis, tubular distension, basophilic renal tubules, increased concentrations of urea and creatinine in plasma), these are considered secondary (after hypotensive) effect of the drug leading to a decrease in renal perfusion. Moreover, irbesartan induced hyperplasia or hypertrophy of juxtaglomerular cells (in rats at a dose of ≥90 mg/kg/day, in macaques ≥10 mg/kg/day). All these changes were considered to be a consequence of the pharmacological action of irbesartan. At therapeutic doses of irbesartan, hyperplasia and hypertrophy of human renal juxtaglomerular cells does not have any significance.

No evidence of mutagenicity, clastogenicity or carcinogenicity was observed.

Animal studies of irbesartan revealed transient toxic effects on the rat fetus (enlargement of the renal pelvic cavity, hydroureter and subcutaneous edema), which resolved after birth. Abortions or early resorption have been reported in rabbits at doses causing significant maternal toxicity, including mortality. No teratogenic effect was observed in rats and rabbits.

Interaction

Aprovel when used with potassium supplements can cause an increase in potassium in the blood. Thiazide diuretics enhance its hypotensive effect.

Drugs containing aliskiren should not be used in combination with Aprovel for diabetes mellitus or renal failure , since there is a high risk of a significant decrease in blood pressure, impaired renal function and the occurrence of hyperkalemia .

When used with lithium , monitoring of lithium in the blood is recommended.

NSAIDs weaken the hypotensive effect, increase potassium levels and the risk of renal dysfunction.

Irbesartan does not affect the pharmacokinetics of digoxin .

Aprovel, 300 mg, film-coated tablets, 14 pcs.

Irbesartan is a selective antagonist of angiotensin II receptors (AT1 type). Irbesartan does not require metabolic activation to acquire pharmacological activity. Angiotensin II is an important component of the RAAS and is involved in the pathogenesis of arterial hypertension, as well as sodium homeostasis.

Blocks all physiologically significant effects of angiotensin II, regardless of the source or route of its synthesis, incl. its strongly pronounced vasoconstrictor and aldosterone-secreting effects, realized through AT1 type receptors located on the surface of vascular smooth muscle cells and in the adrenal cortex. It does not have agonistic activity for AT1 receptors and has a much greater (more than 8500 times) affinity for AT1 receptors than for AT2 receptors (receptors not associated with the regulation of the cardiovascular system).

Irbesartan does not inhibit RAAS enzymes (such as renin, ACE) and does not affect other hormone receptors or ion channels involved in the regulation of blood pressure and sodium homeostasis. Blocking AT1 receptors with irbesartan interrupts the feedback chain in the renin-angiotensin system, which leads to an increase in plasma concentrations of renin and angiotensin II. After taking irbesartan in recommended doses, the plasma concentration of aldosterone decreases, without having a significant effect on the content of potassium in the blood serum (the average increase is <0.1 mEq/L). Irbesartan does not have a significant effect on serum concentrations of triglycerides, cholesterol and glucose. Irbesartan does not affect the concentration of uric acid in the blood serum or the rate of excretion of uric acid by the kidneys.

The antihypertensive effect of irbesartan appears after taking its first dose and becomes significant within 1–2 weeks of administration; its maximum antihypertensive effect is achieved by the 4–6th week of treatment. In long-term clinical studies, the antihypertensive effect of irbesartan was observed to persist for more than one year.

The antihypertensive effect with a single daily dose of irbesartan in doses up to 900 mg is dose-dependent. Irbesartan, when taken once a day in doses of 150–300 mg, reduces blood pressure, measured in a lying or sitting position at the end of the interdose interval (24 hours after taking a dose of irbesartan, i.e. before taking the next dose), by an average of 8– 13/5–8 mm Hg. (sBP/dBP) compared with placebo. The antihypertensive effect of irbesartan before taking the next dose is 60–70% of the maximum values for the reduction in DBP and SBP. The optimal reduction in blood pressure within 24 hours is achieved by taking irbesartan once a day.

Irbesartan reduces blood pressure to approximately the same extent in a standing and lying position. Orthostatic effects are rare, but as with ACE inhibitors, in patients with hyponatremia and/or hypovolemia, an excessive decrease in blood pressure with clinical manifestations is possible.

The antihypertensive effect of irbesartan and thiazide diuretics is additive. In patients with insufficient reduction in blood pressure during monotherapy with irbesartan, adding low doses of hydrochlorothiazide (12.5 mg) once a day to its administration leads to an additional reduction in sBP/dBP by 7-10/3-6 mmHg. compared to adding placebo.

The effectiveness of irbesartan does not depend on age or gender. As with the use of other drugs that affect the RAAS, the antihypertensive effect of irbesartan in patients of the Negroid race is noticeably less pronounced. However, when irbesartan is used simultaneously with low doses of hydrochlorothiazide (for example, 12.5 mg/day), the antihypertensive response in black patients approaches the effectiveness of that in Caucasian patients.

After discontinuation of irbesartan, blood pressure returns to its original level gradually. There is no withdrawal syndrome observed.

In a multicenter, randomized, active substance (amlodipine) versus placebo, double-blind clinical trial, the IDNT trial was conducted in 1715 hypertensive patients with type 2 diabetes mellitus (proteinuria ≥900 mg/day and serum creatinine concentration in the range of 1–3 mg/dL ), showed a 20% (p=0.024) reduction (compared with placebo) and 23% (p=0.006) reduction (compared with amlodipine) in the relative risk of the first occurrence of any of the following conditions: doubling of serum creatinine concentration, development of end-stage disease renal failure or death from any cause (if a comparable reduction in blood pressure is achieved when using irbesartan and amlodipine).

In a multicenter, randomized, placebo-controlled, double-blind clinical trial examining the effects of irbesartan on microalbuminuria in patients with hypertension and type 2 diabetes mellitus (IRMA 2), conducted in 590 patients with arterial hypertension and type 2 diabetes mellitus with microalbuminuria (20–200 mcg/min, 30–300 mg/day) and normal renal function (serum creatinine <1.5 mg/dL in men and <1.1 mg/dL in women), the effect of long-term treatment (over 2 years) was assessed. with Aprovel® on the progression of clinically significant proteinuria. When taking the drug at a dose of 300 mg/day, a 70% reduction in the relative risk of developing clinically significant proteinuria was demonstrated (compared with placebo, p = 0.0004), and at a dose of 150 mg - a 39% reduction in the relative risk of developing clinically significant proteinuria (by compared with placebo, p=0.085). A slowdown in the progression of clinically significant proteinuria was noted after 3 months and continued throughout the entire 2-year clinical study period. The decrease in 24-hour Cl creatinine did not differ significantly between treatment groups. Regression of microalbuminuria to normal albuminuria levels (<20 mcg/min; <30 mg/day) was more often observed in the Aprovel® drug group at a dose of 300 mg (34%) compared to the placebo group (21%).

Analogs

Level 4 ATC code matches:
Telmisartan

Irbesartan

Presartan

Nortivan

Candesartan

Kozaar

Teveten

Blocktran

Cardosal

Valsartan

Losartan

Atakand

Diovan

Valsacor

Mikardis

Vazar

Valz

Lorista

Lozap

Ibertan , Irsar , Irbesartan , Firmasta .

Reviews

Many patients note the effectiveness and ease of use of this drug. In terms of its hypotensive effect, this drug is not inferior to ACE . The hypotensive effect lasts 24 hours, so Aprovel is taken once a day. Patients note a dose-dependent decrease in blood pressure.

“With Aprovel, I achieved stabilization of blood pressure after a stroke. I measure my blood pressure 3 times a day."

“I started taking this drug after Lisinopril, which caused a sore throat and coughing.”

Side effects are transient and the main thing is that there are no undesirable effects characteristic of ACE (in particular, cough). It is noted that the main disadvantage of this drug is its rather high cost.

Aprovel tablets ppo 150mg No. 28

Compound

Active substance: irbesartan 150 mg.
Excipients: lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, hypromellose, magnesium stearate, silicon dioxide. Film shell composition: white dye*, carnauba wax.

Pharmacokinetics

Suction

After oral administration, irbesartan is quickly and completely absorbed. Cmax of irbesartan in blood plasma is achieved 1.5-2 hours after oral administration. Absolute bioavailability is 60-80%. Concomitant food intake does not significantly affect the bioavailability of the drug.

Distribution

Plasma protein binding is approximately 96%. Binding to cellular components of blood is negligible. Vd is 53-93 l.

With daily intake of irbesartan 1 time/day, Css is achieved after 3 days, while its limited accumulation in plasma is observed (less than +20%).

Metabolism

After oral or intravenous administration of 14C-irbesartan, 80-85% of the radioactivity in circulating plasma is unchanged irbesartan.

Irbesartan is metabolized in the liver by oxidation and conjugation with glucuronic acid. The oxidation of irbesartan occurs mainly with the participation of the CYP2C9 isoenzyme; the participation of the CYP3A4 isoenzyme in the metabolism of irbesartan is insignificant. The main metabolite found in the systemic circulation is irbesartan glucuronide (about 6%).

Irbesartan is not metabolized by most isoenzymes that are usually involved in the metabolism of drugs (isoenzymes CYP1A1, CYP1A2, CYP2A6, CYP2B6, CYP2D6 or CYP2E1), and does not cause their inhibition or induction. Irbesartan does not induce or inhibit the CYP3A4 isoenzyme.

Removal

Irbesartan and its metabolites are excreted from the body, both through the intestines and the kidneys. Less than 2% of the administered dose is excreted by the kidneys as unchanged irbesartan. The final T1/2 is 11-15 hours. The total clearance of intravenously administered irbesartan is 157-176 ml/min, and its renal clearance is 3-3.5 ml/min.

Pharmacokinetics in special clinical situations

Floor. Women (compared to men) had slightly higher plasma concentrations of irbesartan. However, no gender-related differences in T1/2 and accumulation of irbesartan were detected. No dose adjustment of irbesartan is required in women. There were no gender-related differences in the effects of irbesartan.

Elderly patients. The AUC and Cmax values of irbesartan in elderly patients (65-80 years) with clinically normal renal and hepatic function were approximately 20-50% higher than in younger patients (18-40 years). Final T1/2 values were comparable. There were no age-related differences in the effects of irbesartan.

Liver dysfunction. In patients with mild (functional class A or 5-6 points on the Child-Pugh scale) and moderately severe (functional class B or 7-9 points on the Child-Pugh scale) liver failure due to cirrhosis, the pharmacokinetic parameters of irbesartan do not change significantly.

Renal dysfunction. In patients with impaired renal function or patients undergoing hemodialysis, the pharmacokinetics of irbesartan do not change significantly. Irbesartan is not excreted from the body by hemodialysis.

Race. In representatives of the Negroid race without arterial hypertension, the AUC and T1/2 of irbesartan are approximately 20-25% higher than in representatives of the Caucasian race; Their Cmax of irbesartan was almost similar to that of representatives of the Caucasian race.

Indications for use

Arterial hypertension (as monotherapy and in combination with other antihypertensive drugs, for example, thiazide diuretics, beta-blockers, long-acting slow calcium channel blockers);
nephropathy in arterial hypertension and type 2 diabetes mellitus (as part of combination antihypertensive therapy).

Contraindications

Hypersensitivity to irbesartan or any of the excipients of the drug;
severe liver failure (functional class C or more than 9 points on the Child-Pugh scale) (lack of experience in clinical use);
simultaneous use with drugs containing aliskiren in patients with diabetes mellitus and/or with moderate to severe renal failure (GFR <60 ml/min/1.73 m2 body surface area);
simultaneous use with ACE inhibitors in patients with diabetic nephropathy;
pregnancy;
lactation period (breastfeeding);
age under 18 years (efficacy and safety have not been established);
hereditary galactose intolerance, lactase deficiency or glucose/galactose malabsorption syndrome;

Carefully

with stenosis of the aortic or mitral valve, hypertrophic obstructive cardiomyopathy;
with hypovolemia, hyponatremia, which occurs, for example, during intensive treatment with diuretics, hemodialysis, diarrhea, vomiting, following a diet with limited salt intake (risk of excessive reduction in blood pressure);
in patients with renal function dependent on the activity of the RAAS, such as patients with arterial hypertension with bilateral or unilateral renal artery stenosis or patients with chronic heart failure of functional class III-IV (according to the NYHA classification);
with ischemic heart disease and/or clinically significant cerebral atherosclerosis (with an excessive decrease in blood pressure, there is a risk of increased ischemic disorders, including the development of acute myocardial infarction and stroke);
in case of renal failure (monitoring of potassium levels and creatinine concentrations in the blood is required), recent kidney transplantation (lack of experience in clinical use);
with simultaneous use of NSAIDs, including selective COX-2 inhibitors (increased risk of renal dysfunction, including the possibility of acute renal failure and increased serum potassium, especially in elderly patients, patients with hypovolemia [including patients taking diuretics] or patients with impaired renal function);
when used in combination with ACE inhibitors or aliskiren, since, compared with monotherapy, with double blockade of the RAAS there is an increased risk of developing an excessive decrease in blood pressure, hyperkalemia and renal dysfunction;
in patients with psoriasis (including a history) due to a possible exacerbation of psoriasis.

Directions for use and doses

The drug is taken orally, regardless of food intake. Swallow the tablet whole with water.

The initial dose is 150 mg 1 time/day.

For patients in whom additional reduction in blood pressure is required to achieve target blood pressure values, the dose can be increased to 300 mg 1 time / day.

In case of insufficient reduction in blood pressure during monotherapy with irbesartan, diuretics (for example, hydrochlorothiazide 12.5 mg / day) or other antihypertensive drugs (for example, beta-blockers, long-acting calcium channel blockers) can be added to treatment.

In patients with nephropathy due to arterial hypertension and type 2 diabetes mellitus, the preferred maintenance dose is 300 mg 1 time / day.

The maximum daily dose is 300 mg/day.

The use of the drug in children and adolescents under the age of 18 is contraindicated (there is insufficient clinical data on the safety and effectiveness of the drug).

Elderly patients (over 65 years): no dose adjustment is required.

Patients with impaired renal function: no dose adjustment is required.

Patients with impaired liver function: in patients with mild to moderate hepatic impairment (5-9 points on the Child-Pugh scale), no dose adjustment is required. There is no experience with the use of the drug in patients with severe liver failure.

Patients with hypovolemia: in patients with severe hypovolemia and/or hyponatremia, such as patients receiving intensive diuretic therapy or on hemodialysis, hypovolemia and hyponatremia should be corrected before using Aprovel®.

Storage conditions

The drug should be stored out of the reach of children at a temperature not exceeding 30°C.

Best before date

3 years. Do not use the drug after the expiration date indicated on the package.

special instructions

Excessive decrease in blood pressure in patients with hypovolemia

The use of the drug Aprovel® has so far rarely been accompanied by an excessive decrease in blood pressure in patients with arterial hypertension without concomitant diseases. As with the use of ACE inhibitors, an excessive decrease in blood pressure, accompanied by clinical symptoms, can develop in patients with hyponatremia/hypovolemia (for example, as a result of intensive diuretic therapy, diarrhea or vomiting, following a diet with limited sodium intake), as well as in patients on hemodialysis. Before starting the use of Aprovel®, it is necessary to correct hypovolemia and/or hyponatremia.

Patients with renal function dependent on RAAS activity

Due to inhibition of the RAAS, deterioration of renal function can be expected in predisposed patients. In patients with renal function dependent on the activity of the RAAS (patients with arterial hypertension and renal artery stenosis of one or both kidneys or patients with chronic heart failure of NYHA functional classes III and IV), treatment with drugs that affect the RAAS was associated with oliguria and/or progressive azotemia and rarely with acute renal failure and/or death. The possibility of a similar effect when using angiotensin II receptor antagonists, including irbesartan, cannot be excluded.

Kidney failure and kidney transplant

When using Aprovel® in patients with renal failure, periodic monitoring of serum potassium and creatinine concentrations is recommended. There are no clinical data regarding the use of Aprovel® in patients who have undergone kidney transplantation.

Patients with arterial hypertension and type 2 diabetes mellitus with impaired renal function

The beneficial effect of Aprovel® in slowing the progression of renal and cardiovascular disorders had varying degrees of severity in different groups of patients: it was less pronounced in women and non-Caucasian patients.

In the IDNT clinical trial in patients with arterial hypertension and type 2 diabetes mellitus with proteinuria (≥900 mg/day), in the subgroup of patients at high risk of renal artery stenosis, no acute early increase in concentration was observed in any patient taking Aprovel® serum creatinine associated with renal artery stenosis.

Double blockade of the RAAS with simultaneous use of irbesartan with ACE inhibitors or aliskiren

Double blockade of the RAAS when using a combination of irbesartan with ACE inhibitors or aliskiren is not recommended, because Compared with monotherapy, there is an increased risk of a sharp decrease in blood pressure, the development of hyperkalemia and renal dysfunction.

Concomitant use of irbesartan with aliskiren or drugs containing aliskiren is contraindicated in patients with diabetes mellitus and/or moderate or severe renal impairment with GFR <60 ml/min/1.73 m2 body surface area and is not recommended in other patients.

Concomitant use of irbesartan with ACE inhibitors is contraindicated in patients with diabetic nephropathy and is not recommended in other patients.

Psoriasis

In patients with psoriasis (including a history of psoriasis), the decision to use the drug should be made only after a thorough assessment of the risk/benefit ratio due to the possible exacerbation of psoriasis.

Hyperkalemia

As with the use of other drugs that affect the RAAS, hyperkalemia may develop during treatment with Aprovel®, especially in the presence of renal failure and/or heart disease. In such patients, it is recommended to monitor serum potassium levels.

Aortic or mitral valve stenosis, obstructive hypertrophic cardiomyopathy

As with the use of other vasodilators, caution is required when prescribing Aprovel® to patients with aortic or mitral stenosis or hypertrophic obstructive cardiomyopathy.

Primary hyperaldosteronism

Patients with primary hyperaldosteronism usually do not respond to antihypertensive drugs that inhibit the RAAS. Therefore, the use of Aprovel® in such cases is not advisable.

IHD and/or clinically significant cerebral atherosclerosis

As with the use of other antihypertensive drugs, a significant decrease in blood pressure in patients with coronary artery disease and/or severe cerebral atherosclerosis can lead to the development of myocardial infarction or stroke. Treatment should be carried out under blood pressure monitoring.

Description

Angiotensin II receptor antagonist.

Use in children

The use of the drug is contraindicated in children and adolescents under 18 years of age (efficacy and safety have not been established).

Pharmacodynamics

Selective antagonist of angiotensin II receptors (AT1 type). Irbesartan does not require metabolic activation to acquire pharmacological activity.

Angiotensin II is an important component of the RAAS and is involved in the pathogenesis of arterial hypertension, as well as sodium homeostasis. Irbesartan blocks all physiologically significant effects of angiotensin II, regardless of the source or route of its synthesis, incl. a pronounced vasoconstrictor effect and increased secretion of aldosterone, realized through AT1 type receptors located on the surface of vascular smooth muscle cells and in the adrenal cortex. Irbesartan does not have agonistic activity against AT1 receptors and has a much greater (more than 8500 times) affinity for AT1 receptors than for AT2 receptors (receptors not associated with the regulation of the cardiovascular system).

Irbesartan has no significant effect on serum concentrations of triglycerides, cholesterol and glucose. Irbesartan does not affect the concentration of uric acid in the blood serum or the rate of excretion of uric acid by the kidneys.

The antihypertensive effect of irbesartan appears after taking its first dose and becomes significant within 1-2 weeks of administration, its maximum antihypertensive effect is achieved by 4-6 weeks of treatment. In long-term clinical studies, the antihypertensive effect of irbesartan was observed to persist for more than one year.

The antihypertensive effect with a single daily dose of irbesartan in doses up to 900 mg is dose-dependent. Irbesartan, when taken once a day in doses of 150-300 mg, reduces blood pressure, measured in a lying or sitting position at the end of the interdose interval (24 hours after taking a dose of irbesartan, i.e. before taking the next dose of irbesartan), by an average of 8 -13/5-8 mm Hg. Art. (systolic/diastolic blood pressure) compared with placebo. The antihypertensive effect of irbesartan before taking the next dose is 60-70% of the maximum values for reducing diastolic and systolic blood pressure. The optimal reduction in blood pressure within 24 hours is achieved by taking irbesartan once a day.

Irbesartan reduces blood pressure to approximately the same extent in a standing and lying position. Orthostatic effects are rare, however, as with ACE inhibitors, in patients with hyponatremia and/or hypovolemia, an excessive decrease in blood pressure with clinical manifestations is possible.

The antihypertensive effect of irbesartan and thiazide diuretics is additive. In patients with insufficient reduction in blood pressure during monotherapy with irbesartan, the addition of hydrochlorothiazide in low doses (12.5 mg) once a day to its intake leads to an additional decrease in blood pressure by 7-10/3-6 mm Hg. (systolic/diastolic) versus adding placebo.

The effectiveness of irbesartan does not depend on age or gender. As with the use of other drugs that affect the RASS, the antihypertensive effect of irbesartan in black patients is noticeably less pronounced, however, when irbesartan is used simultaneously with hydrochlorothiazide in low doses (for example, 12.5 mg / day), the antihypertensive response in black patients approaches effectiveness to that in Caucasian patients.

After discontinuation of irbesartan, blood pressure returns to its original level gradually. There is no withdrawal syndrome observed.

In patients with hypertension and type 2 diabetes mellitus receiving irbesartan 300 mg, there was a 20% reduction (compared with placebo) and 23% reduction (compared with amlodipine 10 mg) in the relative risk of the first occurrence of any of the following conditions : doubling of serum creatinine concentration, development of end-stage renal failure or death from any cause (with a comparable reduction in blood pressure achieved when using irbesartan and amlodipine).

Side effects

The safety of Aprovel® was studied in clinical studies in approximately 5000 patients, including 1300 patients with hypertension who took the drug for more than 6 months, and 400 patients who took the drug for 1 year or more. Adverse events in patients taking Aprovel® were usually moderate and transient, and their frequency did not depend on the dose taken, as well as gender, age and race.

In placebo-controlled studies in which 1965 patients took irbesartan (for an average of 1-3 months), discontinuation of treatment due to the development of any clinical or laboratory adverse reactions was required in 3.3% of patients taking Aprovel®, and in 4.5% of patients taking placebo (differences were statistically significant).

In patients with nephropathy in arterial hypertension and type 2 diabetes mellitus (clinical studies IDNT and IRMA 2), adverse events are similar to those in patients with arterial hypertension, with the exception of orthostatic symptoms (dizziness (10.2%) (with placebo 6%), orthostatic dizziness (5.4%) (2.7% with placebo) and orthostatic hypotension (5.4%) (3.2% with placebo).

Treatment discontinuation rates due to orthostatic symptoms with Aprovel compared with placebo were 0.3% versus 0.5% for dizziness, 0.2% versus 0.0% for orthostatic dizziness, and 0.0% versus 0.0% for orthostatic hypotension, respectively.

The incidence of adverse reactions was determined according to the WHO classification: very often (≥1/10), often (≥1/100, <1/10), infrequently (≥1/1000, <1/100), rarely (≥1 /10,000, <1/1000), very rare (<1/10,000), frequency unknown (cannot be calculated based on available data).

The following are adverse reactions observed in clinical studies in patients with arterial hypertension1, in patients with nephropathy in arterial hypertension and type 2 diabetes mellitus (clinical studies IDNT and IRMA 2)2 or during post-marketing use of the drug3.

From the hematopoietic system: frequency unknown - thrombocytopenia, incl. thrombocytopenic purpura1.

From the immune system: frequency unknown - hypersensitivity reactions3 (such as angioedema, skin rash, urticaria, anaphylactic reactions, anaphylactic shock).

From the side of metabolism and nutrition: frequency unknown - hyperkalemia3.

From the nervous system: often - dizziness1,2, orthostatic dizziness2, headache1; infrequently - orthostatic dizziness1; frequency unknown - vertigo1.

On the part of the hearing organ: frequency unknown - ringing in the ears3.

From the cardiovascular system: often - orthostatic hypotension2; infrequently - edema1, tachycardia1, flushing1.

From the respiratory system: infrequently - cough1.

From the digestive system: often - nausea1, vomiting1; infrequently - diarrhea1, dyspepsia1, heartburn1; frequency unknown - dysgeusia1.

From the liver and biliary tract: infrequently - jaundice3; frequency unknown - increased activity of liver enzymes1 and bilirubin concentration in the blood3, hepatitis3.

From the skin and subcutaneous tissues: frequency unknown - leukocytoclastic vasculitis3, psoriasis1, incl. increased manifestation of psoriasis symptoms, photosensitivity reactions3.

From the musculoskeletal system: often - musculoskeletal pain2; frequency unknown - myalgia1 (in some cases may be associated with an increase in the concentration of creatine kinase in the blood plasma), arthralgia3, muscle spasms3.

From the urinary system: frequency unknown - renal dysfunction3, incl. cases of renal failure in patients at risk.

From the genital organs and breast: uncommon - sexual dysfunction1.

Other: often - increased fatigue1; uncommon - chest pain1; frequency unknown - asthenia1.

From the data of laboratory and instrumental studies: during controlled clinical studies in patients with arterial hypertension, no clinically significant changes in laboratory parameters were observed. No special monitoring of laboratory parameters is required for patients with arterial hypertension taking Aprovel®.

Hyperkalemia2: In the IDNT clinical trial, the percentage of patients with hyperkalemia (>6 mEq/L) was 18.6% in the Aprovel group compared to 6.0% in the placebo group. In the IRMA 2 clinical trial, the percentage of patients with hyperkalemia (>6 mEq/L) was 1.0% in the Aprovel® drug group, and no hyperkalemia was observed in the placebo group. In the IDNT clinical trial, treatment discontinuation rates due to hyperkalemia with Aprovel and placebo were 2.1% and 0.36%, respectively. In the IRMA clinical trial, the rate of treatment discontinuation due to hyperkalemia when taking Aprovel® and placebo was 0.5% and 0%, respectively.

Use during pregnancy and breastfeeding

Pregnancy

There is no experience with the use of irbesartan during pregnancy. Considering that when pregnant women took ACE inhibitors in the second and third trimesters of pregnancy, damage and death of the developing fetus were observed, irbesartan, like any other drug that acts directly on the RAAS, should not be used during pregnancy (I, II, III trimesters ).

If pregnancy is diagnosed during treatment, the drug should be discontinued immediately.

Breastfeeding period

Irbesartan is excreted in milk in lactating rats. It is not known whether irbesartan/its metabolites can be excreted in breast milk in women. Irbesartan is contraindicated during breastfeeding. Therefore, after assessing the ratio of the expected benefit of taking the drug for the mother and the potential risk for the child, either breastfeeding or taking irbesartan should be stopped.

Fertility

In studies in male and female rats, irbesartan did not affect fertility or reproductive function, even at doses that had some parental toxicity (up to 650 mg/kg/day). There was no significant effect on the number of corpora lutea, implanted embryos or live fetuses. Irbesartan did not affect survival, development or reproduction of offspring.

Interaction

Based on data from in vitro studies, irbesartan is not expected to interact with drugs metabolized by the isoenzymes CYP1A1, CYP1A2, CYP2A6, CYP2B6, CYP2E1 or CYP3A4. Irbesartan is mainly metabolized by the CYP2C9 isoenzyme and, to a lesser extent, undergoes glucuronidation. No significant pharmacokinetic and pharmacodynamic interactions were observed when irbesartan was co-administered with warfarin, a drug metabolized by the CYP2C9 isoenzyme. Irbesartan does not change the pharmacokinetics of digoxin and simvastatin. When irbesartan is co-administered with hydrochlorothiazide or nifedipine, the pharmacokinetics of irbesartan does not change.

Medicines containing aliskiren

Concomitant use of irbesartan with medicinal products containing aliskiren is contraindicated in patients with diabetes mellitus or with moderate to severe renal impairment (GFR <60 ml/min/1.73 m2 body surface area) and is not recommended in other patients.

ACE inhibitors

The use of irbesartan in combination with ACE inhibitors is contraindicated in patients with diabetic nephropathy and is not recommended in other patients.

Potassium supplements and potassium-sparing diuretics, heparin

Based on the experience gained with the use of other drugs that affect the RAAS, with the simultaneous use of potassium preparations; salt substitutes containing potassium; Potassium-sparing diuretics or other drugs that can increase blood potassium levels (heparin) can sometimes significantly increase serum potassium concentrations, which requires careful monitoring of plasma potassium levels in patients during treatment.

NSAIDs, including selective COX-2 inhibitors

With simultaneous use of angiotensin II receptor antagonists and NSAIDs (including selective COX-2 inhibitors), the hypotensive effect of irbesartan may be weakened. In elderly patients, patients with hypovolemia, or patients with impaired renal function, the use of NSAIDs, including COX-2 inhibitors, concomitantly with angiotensin II receptor antagonists, including irbesartan, may lead to a deterioration of renal function, including the possible development of acute renal failure. These effects are usually reversible. Renal function should be periodically monitored in patients taking irbesartan and NSAIDs, including COX-2 inhibitors, concomitantly.

Lithium preparations

An increase in the concentration of lithium in the blood serum and an increase in its toxicity have been reported with the simultaneous use of lithium salts with irbesartan.

Diuretics and other antihypertensive drugs

With simultaneous use of irbesartan and other antihypertensive drugs, the antihypertensive effect may be enhanced. Irbesartan has been used concomitantly with other antihypertensive agents, such as beta-blockers, long-acting calcium channel blockers and thiazide diuretics, without any undesirable effects.

Previous treatment with diuretics in high doses may lead to hypovolemia and an increased risk of excessive reduction in blood pressure at the beginning of treatment with Aprovel®.

Overdose

Experience with the use of the drug in adult patients in doses up to 900 mg/day for 8 weeks did not reveal any toxicity.

Treatment: There is no specific information regarding the treatment of overdose of Aprovel®. In case of overdose, it is recommended to induce vomiting and/or perform gastric lavage. Constant monitoring of the patient's condition should be established and, if necessary, symptomatic and supportive therapy should be provided. Irbesartan is not excreted from the body by hemodialysis.

Impact on the ability to drive vehicles and operate machinery

The effect of the drug on the ability to drive vehicles or engage in other potentially hazardous activities that require increased attention and high speed of psychomotor reactions has not been studied. However, based on its pharmacodynamic properties, the drug should not affect the ability to drive vehicles and engage in other potentially hazardous activities (including working at heights, working as an air traffic controller, working with machinery). If dizziness and weakness occur, attention may decrease and psychomotor reactions may slow, so care must be taken when operating vehicles and machinery.

Aprovel price, where to buy

You can buy it in many pharmacies in Moscow. The price of Aprovel in tablets of 150 mg No. 28 ranges from 599 rubles. up to 1409 rubles, and 300 mg tablets No. 28 - from 807 rubles. up to 1607 rub. In pharmacies you can also buy Coaprovel tablets 300 mg / 12.5 mg No. 28 at a price of 1557-2110 rubles.

Online pharmacies in RussiaRussia
Online pharmacies in UkraineUkraine

ZdravCity

Coaprovel tablets 150mg+12.5mg 28 pcs.Sanofi-Winthrop Industrie
RUB 738 order
Coaprovel film-coated tablets 300mg+25mg 28 pcs. Sanofi Winthrop Industry
RUR 993 order
Coaprovel tablets 300mg+12.5mg 28 pcs.Sanofi-Winthrop Industrie
970 rub. order

Pharmacy Dialogue

Coaprovel tablets 150/12.5 mg No. 28Sanofi-Winthrop Industrie
RUR 868 order
Coaprovel tablets 300/12.5 mg No. 28Sanofi-Winthrop Industrie
RUB 1,144 order
Coaprovel tablets 300/25 mg No. 28Sanofi-Winthrop Industrie
RUR 984 order