Nurses Compass
Drug Guide
Azilsartan Kamedoxomil and Chlorthalidone
Classification
Therapeutic: Antihypertensive combination
Pharmacological: Angiotensin II receptor blocker (Azilsartan) and thiazide-like diuretic (Chlorthalidone)
FDA Approved Indications
- Hypertension to lower blood pressure
Mechanism of Action
Azilsartan Kamedoxomil blocks angiotensin II from binding to the AT1 receptor, causing vasodilation and decreased blood pressure. Chlorthalidone promotes diuresis by inhibiting sodium and chloride reabsorption in the distal nephron, reducing blood volume and pressure.
Dosage and Administration
Adult: Typically, 80 mg of Azilsartan with 12.5-25 mg of Chlorthalidone once daily, adjusted based on response.
Pediatric: Not established for pediatric use.
Geriatric: Use with caution; start at lower doses due to increased sensitivity and risk of hypotension.
Renal Impairment: Adjust dosage based on renal function; monitor frequently.
Hepatic Impairment: Use with caution; no specific dose adjustment established.
Pharmacokinetics
Absorption: Azilsartan is well absorbed with food; Chlorthalidone has variable absorption.
Distribution: Azilsartan is extensively protein-bound; Chlorthalidone is highly protein-bound.
Metabolism: Azilsartan is metabolized minimally; Chlorthalidone undergoes hepatic metabolism.
Excretion: Both drugs are mainly excreted via kidneys.
Half Life: Azilsartan approximately 11 hours; Chlorthalidone approximately 40-50 hours.
Contraindications
- Hypersensitivity to either component.
- Pregnancy (especially after the first trimester).
Precautions
- Renal impairment, hepatic impairment, volume depletion, electrolyte disturbances, concomitant use with other antihypertensives or diuretics, monitor blood pressure and electrolytes regularly.
Adverse Reactions - Common
- Dizziness (Common)
- Hypotension (Common)
- Electrolyte imbalances (e.g., hyperkalemia, hyponatremia) (Common)
Adverse Reactions - Serious
- Angioedema (Rare)
- Acute kidney injury (Rare)
- Severe hypotension (Rare)
Drug-Drug Interactions
- Other antihypertensives, potassium supplements, NSAIDs, lithium.
Drug-Food Interactions
- Avoid excessive potassium-rich foods due to hyperkalemia risk.
Drug-Herb Interactions
- Caution with herbal diuretics or supplements affecting blood pressure or electrolytes.
Nursing Implications
Assessment: Monitor blood pressure, renal function, serum electrolytes before and during therapy.
Diagnoses:
- Risk for electrolyte imbalance
- Ineffective tissue perfusion related to hypotension.
Implementation: Administer as directed, monitor vital signs and labs regularly, educate patient on symptoms of hypotension and electrolyte disturbances.
Evaluation: Assess blood pressure and labs to determine therapeutic effectiveness and safety.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Report signs of dizziness, swelling, or unusual side effects.
- Avoid potassium-rich foods and supplements unless directed.
- Do not discontinue abruptly.
Special Considerations
Black Box Warnings:
- Pregnancy: Drugs that act on the renin-angiotensin system can cause injury and death to the developing fetus.
Genetic Factors: Some populations may have different responses; monitor accordingly.
Lab Test Interference: May alter potassium, kidney function tests.
Overdose Management
Signs/Symptoms: Severe hypotension, dizziness, electrolyte disturbances.
Treatment: Discontinue medication, restore blood volume with IV fluids, monitor electrolytes, treat hypotension symptomatically.
Storage and Handling
Storage: Store at room temperature, away from moisture and heat.
Stability: Stable under recommended conditions.