Correct volume or salt depletion prior to administration of AVAPRO or use a lower starting dose Changes in renal function including acute renal failure can be caused by drugs that inhibit the renin-angiotensin system. Closely monitor blood pressure, renal function and electrolytes in patients on AVAPRO and other agents that affect the RAS. Monitor renal function periodically in patients receiving irbesartan and NSAID therapy.The antihypertensive effect of angiotensin II receptor antagonists, including irbesartan, may be attenuated by NSAIDs including selective COX-2 inhibitors.Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren is associated with increased risks of hypotension, hyperkalemia, and changes in renal function (including acute renal failure) compared to monotherapy. In studies of hypertensive patients, there is no sex difference in half-life or accumulation, but somewhat higher plasma concentrations of irbesartan are observed in females (11%–44%). In pregnant rabbits, oral doses of 30 mg irbesartan/kg/day were associated with maternal mortality and abortion. Irbesartan is slightly soluble in alcohol and methylene chloride and practically insoluble in water.AVAPRO is available for oral administration in unscored, film-coated tablets containing 75 mg, 150 mg, or 300 mg of irbesartan. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of NSAIDs, including selective COX-2 inhibitors, with angiotensin II receptor antagonists (including irbesartan) may result in deterioration of renal function, including possible acute renal failure. AVAPRO 150 mg is a white to off-white, biconvex oval, film-coated, tablet debossed with a heart on one side and "2872" on the other. The observed effects are believed to be late gestational effects of the drug. For specific advice on goals and management, see published guidelines, such as those of the National High Blood Pressure Education Program's Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC). Irbesartan was effective in reducing blood pressure regardless of race, although the effect was somewhat less in blacks (usually a low-renin population).The effect of irbesartan is apparent after the first dose, and it is close to its full observed effect at 2 weeks. The dose-response relationships for effects on systolic and diastolic pressure are shown in Figures 1 and 2.Once-daily administration of therapeutic doses of irbesartan gave peak effects at around 3 to 6 hours and, in one ambulatory blood pressure monitoring study, again around 14 hours. Inactive ingredients include: carnauba wax, croscarmellose sodium, hypromellose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, silicon dioxide, and titanium dioxide.Angiotensin II is a potent vasoconstrictor formed from angiotensin I in a reaction catalyzed by angiotensin-converting enzyme (ACE, kininase II). %PDF-1.3 Compared with placebo, AVAPRO significantly reduced proteinuria by about 27%, an effect that was evident within 3 months of starting therapy. See full prescribing information for complete boxed warning.When pregnancy is detected, discontinue AVAPRO as soon as possible. AVAPRO 300 mg is a white to off-white, biconvex oval, film-coated, tablet debossed with a heart on one side and "2873" on the other. This was seen with both once-daily and twice-daily dosing. Avoid use of aliskiren with AVAPRO in patients with renal impairment (GFR <60 mL/min).Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death. Food does not affect the bioavailability of irbesartan.Irbesartan exhibits linear pharmacokinetics over the therapeutic dose range.Irbesartan is 90% bound to serum proteins (primarily albumin and αStudies in animals indicate that radiolabeled irbesartan weakly crosses the blood-brain barrier and placenta.