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Irbesartan
See also Angiotensin II receptor antagonists .
General information
Irbesartan is a potent selective angiotensin II type 1 (AT 1 ) receptor antagonist. Its pharmacology is the same as that of other angiotensin II receptor antagonists [ ]. In the registration studies and other controlled trials adverse effects were not dose-related and not different from placebo.
In an unpublished postmarketing surveillance study 1232 of 9009 patients (14%) had mostly mild adverse events [ ]. No details were given on the nature of the adverse events.
There has been a large post-marketing assessment of irbesartan in 4500 patients followed for 6 months, of whom 2.2% had adverse reactions, most commonly headache, epigastric pain, nausea, and vomiting [ ]. An allergic reaction and syncope due to hypotension were the only serious adverse events.
Organs and systems
Sensory systems
Acute bilateral angle closure glaucoma is often due to an adverse drug reaction in patients who are predisposed by having narrowed angles in the anterior chambers of the eye. This has been reported with a wide variety of agents, including adrenergic agents, antidepressants, sulpha drugs, and ACE inhibitors.
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A 42-year-old woman gradually developed a severe, pulsatile, temporal headache, with nausea, blurred vision, and red eyes 2 weeks after starting to take a combination of irbesartan and hydrochlorothiazide for hypertension [ ]. She was also taking gabapentin and pantoprazole. She had severe bilateral intraocular hypertension and was given topical antiglaucoma treatment. The next day she had laser iridotomy, and her symptoms resolved.
The authors suggested that the timing made a drug-induced cause probable, although they did not specifically discuss the possible contribution of irbesartan. There have been several reports of angle closure glaucoma with hydrochlorothiazide, but only one with angiotensin II receptor antagonists. It is likely that the combination antihypertensive treatment was responsible, but unclear which of the agents (or both) was causative.
Hematologic
A child developed severe treatment-resistant anemia, thought to be due to irbesartan, after receiving a cadaveric renal transplant for kidney disease related to congenital nephrotic syndrome [ ]. Dechallenge resulted in an increase in hemoglobin after 4 weeks, and the authors suggested that a “drug holiday” might be used to test whether hemoglobin increases after withdrawal in such cases.
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