Cavapro

Description

Indications
Cavapro tablets are prescribed for the treatment of essential hypertension. Additionally, they are used as part of an antihypertensive regimen for patients with hypertension and type 2 diabetes mellitus who have renal disease.

Take this medication only as directed by a registered physician.

Pharmacology
Irbesartan, the active ingredient in Cavapro, is an angiotensin II receptor antagonist. It functions by blocking the vasoconstrictive and aldosterone-secreting effects of angiotensin II through selective binding to AT1 receptors, thereby helping to regulate blood pressure.

Dosage & Administration

Adults: The standard initial and maintenance dose is 150 mg once daily, which can be taken with or without food. This dosage typically provides better 24-hour blood pressure control compared to a 75 mg dose. However, an initial dose of 75 mg may be considered for elderly patients over 75 years and those undergoing haemodialysis. If blood pressure is not adequately controlled with 150 mg, the dose can be increased to 300 mg, or an additional antihypertensive agent, such as a diuretic like hydrochlorothiazide, may be introduced.

For hypertensive patients with type 2 diabetes and renal disease, treatment should start with 150 mg once daily and be increased to 300 mg once daily, as this dosage has demonstrated benefits in managing renal disease. Studies have shown that Irbesartan, when combined with other antihypertensive agents, helps achieve target blood pressure levels in these patients.

Elderly: Although therapy initiation with 75 mg may be considered for patients over 75 years, dosage adjustments are typically not necessary.

Paediatric Use: Due to insufficient safety and efficacy data, Irbesartan is not recommended for children and adolescents.

Take this medication only as directed by a registered physician.

Drug Interactions

• Diuretics and other antihypertensives: High-dose diuretic use before starting Cavapro may lead to volume depletion, increasing the risk of hypotension.
• Potassium supplements & potassium-sparing diuretics: Concomitant use of these with Cavapro may cause elevated serum potassium levels and is therefore not recommended.
• Lithium: Combining lithium with Cavapro may lead to reversible increases in serum lithium concentrations, causing toxicity. If this combination is necessary, close monitoring of lithium levels is advised.
• NSAIDs: Non-steroidal anti-inflammatory drugs, including selective COX-2 inhibitors and high-dose aspirin (>3 g/day), may reduce the antihypertensive effect of Cavapro.
• Other interactions: Cavapro is primarily metabolized by CYP2C9 and slightly by glucuronidation. No significant interactions have been observed with warfarin or digoxin. However, the effects of CYP2C9 inducers such as rifampicin remain unstudied.

Contraindications

• Concurrent use with aliskiren in patients with diabetes or renal impairment (GFR <60 ml/min).
• Pregnancy.

Side Effects One advantage of Cavapro is its low incidence of adverse effects compared to ACE inhibitors, particularly regarding cough.

Common Side Effects: Headache, dizziness, fatigue, nausea, and vomiting.

Less Common Side Effects: Anxiety, nervousness, belching, heartburn, stomach discomfort, diarrhea, muscle or bone pain, and unusual tiredness.

Pregnancy & Lactation

• Pregnancy: Irbesartan is contraindicated in the second and third trimesters due to risks of fetal renal failure, skull hypoplasia, and potential fetal death. It should also be avoided in the first trimester as a precaution. If pregnancy is detected, Cavapro should be discontinued immediately, and fetal skull and kidney function should be assessed.
• Lactation: This medication is not recommended during breastfeeding due to unknown excretion in human milk.

Precautions & Warnings

• Patients with unilateral or bilateral renal artery stenosis, intravascular volume depletion, aortic or mitral stenosis, or obstructive hypertrophic cardiomyopathy should use Cavapro with caution.
• In hypertensive type 2 diabetic patients with renal disease, the effects on renal and cardiovascular outcomes may vary depending on individual factors such as sex and ethnicity.
• Patients with primary aldosteronism typically do not respond well to renin-angiotensin system inhibitors, so Cavapro is not recommended in these cases.
• Blood pressure reduction should be monitored carefully in patients with ischemic cardiovascular conditions to prevent myocardial infarction or stroke.

Special Populations

• Renal Impairment: No dosage adjustment is required, but a lower starting dose (75 mg) should be considered for patients undergoing haemodialysis.
• Hepatic Impairment: No dose adjustment is needed for mild to moderate liver impairment, though data is lacking for severe cases.
• Hyperkalaemia: Cavapro may cause increased potassium levels, particularly in patients with renal impairment, diabetic nephropathy, or heart failure. Regular monitoring is advised.

Overdose Effects Doses up to 900 mg/day for eight weeks have not shown toxicity in adults. However, symptoms of overdose may include hypotension and tachycardia, with bradycardia occurring in some cases. There is no specific antidote; treatment is symptomatic and supportive. Activated charcoal may help, but haemodialysis does not effectively remove Cavapro from circulation.

Therapeutic Class Angiotensin II Receptor Blocker (ARB)

Storage Conditions Store in a cool, dry place away from light and moisture