Drug interactions with angiotensin receptor blockers

Abstract

Many patients with high blood pressure receive multiple medications for hypertension and other conditions, placing them at risk for adverse drug interactions. Additionally, as the prevalence of hypertension increases with age, factors like greater frailty, comorbidity of the elderly requiring polypharmacy, and reduced hepatic and renal clearance rates for the elimination of drugs increase the likelihood of drug interactions. Angiotensin receptor blockers (ARBs) are the most recent class of agents for the treatment of hypertension. Due to a favourable side effect profile, this class of drugs deserves increased attention. This article reviews drug interactions of ARBs and suggests measures for reducing the risk of adverse events when drugs are co-administered. MEDLINE, EMBASE, Cochrane library, and CINAHL were searched. Reported and likely clinical relevant interactions of ARBs with concomitantly given drugs are summarised in Table 2 and 3. Compared to other classes of antihypertensive agents, the ARBs appear to have a low potential for drug interactions; however, interactions with this class occur and variations within the class have been detected, mainly due to different affinities for cytochrome P450 isoenzymes.

<p>Pharmacokinetic interactions between telmisartan/amlodipine and rosuvastatin after multiple oral administrations in healthy Korean male subjects</p>

“…Rosuvastatin, however, is not one of such statins. On the other hand, ARBs such as telmisartan rarely show significant interactions with CCBs or statins; only a few pharmacokinetic interactions between ARBs and statins had been reported, such as the one between fimasartan and atorvastatin 11,25,26. Although telmisartan/amlodipine was selected in our study because it was the best-selling antihypertensive combination in South Korea, further studies that investigate the pharmacokinetic interaction between ARBs, CCBs and statins may help in decision making process of developing new fixed dose combination.…”

Management of hypertension in patients with diabetes: the place of angiotensin‐II receptor blockers

“…Few laboratory abnormalities have been attributed to these agents, and discontinuation rates in clinical trials have generally been similar in patients treated with ARBs or placebo [59]. ARBs have a low potential for pharmacokinetic drug–drug interactions compared with other classes of antihypertensive agents; hence, they can be safely administered with all other major antihypertensive drug classes [60,61].…”

Influence of Fimasartan (a Novel AT1Receptor Blocker) on Catecholamine Release in the Adrenal Medulla of Spontaneously Hypertensive Rats

“…By blocking the effects of Ang II, ARBs relax vascular smooth muscle and thereby promote vasodilation, increase renal salt and water excretion, reduce plasma volume, and decrease cellular hypertrophy. Because of their favorable side effect profile with low potential for drug interaction compared with conventional antihypertensive agents, ARBs deserve increased attention [3,4]. Fimasartan demonstrated no clinically meaningful adverse effects from 20 to 480 mg [5,6].…”