Drug Guide
Azilsartan Kamedoxomil
Classification
Therapeutic: Antihypertensive
Pharmacological: Angiotensin II Receptor Blocker (ARB)
FDA Approved Indications
- Hypertension
Mechanism of Action
Azilsartan Kamedoxomil is an angiotensin II receptor blocker that inhibits the vasoconstrictive and aldosterone-secreting effects of angiotensin II by selectively blocking the AT1 receptor subtype, leading to vasodilation and decreased blood pressure.
Dosage and Administration
Adult: Start with 40 mg once daily. Dose may be increased to 80 mg once daily based on response.
Pediatric: Not indicated for pediatric use.
Geriatric: Adjust dosage as needed based on response and tolerability.
Renal Impairment: Use with caution; monitor renal function. No specific dose adjustment recommended, but caution advised.
Hepatic Impairment: Use with caution; dose adjustment not specified.
Pharmacokinetics
Absorption: Well absorbed orally.
Distribution: Approximately 70% bound to plasma proteins.
Metabolism: Metabolized mainly via CYP2C9 and CYP3A4 to inactive metabolites.
Excretion: Excreted primarily in feces (55%) and urine (42%).
Half Life: ~11 hours.
Contraindications
- Pregnancy (category D), due to risk of fetal injury
- Hypersensitivity to azilsartan or other ARBs
Precautions
- History of angioedema related to previous ACE inhibitor or ARB therapy
- Impaired hepatic or renal function, especially bilateral renal artery stenosis
- Monitor blood pressure, renal function, and serum potassium during therapy. Concomitant use of potassium-sparing diuretics or potassium supplements may increase hyperkalemia risk.
Adverse Reactions - Common
- Dizziness (Common)
- Hyperkalemia (Less common)
- Fatigue (Common)
Adverse Reactions - Serious
- Angioedema (Rare)
- Acute renal failure (Rare)
- Hypotension (Less common)
Drug-Drug Interactions
- Potassium-sparing diuretics, potassium supplements, other antihypertensives, NSAIDs that can impair renal function
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood pressure, renal function (serum creatinine, BUN), and serum potassium before and during treatment.
Diagnoses:
- Altered tissue perfusion related to elevated blood pressure
- Risk for electrolyte imbalance
Implementation: Administer according to prescribed schedule. Educate patient on maintaining hydration and avoiding potassium-rich foods if hyperkalemia develops.
Evaluation: Assess blood pressure response; monitor for adverse effects such as hyperkalemia, hypotension, and signs of angioedema.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Notify healthcare provider if swelling of face/tongue, difficulty breathing, or severe dizziness occurs.
- Monitor blood pressure regularly and maintain follow-up appointments.
- Avoid potassium-rich foods and supplements unless directed.
Special Considerations
Black Box Warnings:
- Fetal toxicity: Discontinue as soon as pregnancy is detected.
Genetic Factors: Patients with genetic polymorphisms affecting CYP2C9 or CYP3A4 may have altered drug metabolism.
Lab Test Interference: May increase serum potassium and serum creatinine levels.
Overdose Management
Signs/Symptoms: Hypotension, dizziness, tachycardia, bradycardia.
Treatment: Supportive care, monitor vital signs, and manage hypotension with IV fluids or vasopressors if needed.
Storage and Handling
Storage: Store at room temperature, 20-25°C (68-77°F).
Stability: Stable under recommended storage conditions until expiration date on the package.