What is irbesartan used for. How does irbesartan work to lower blood pressure. What are the recommended dosages for irbesartan. Why have certain irbesartan products been recalled recently. How should patients respond to the irbesartan recall.

What Is Irbesartan and How Does It Work?

Irbesartan is a medication primarily used to treat high blood pressure, also known as hypertension. It belongs to a class of drugs called angiotensin II receptor blockers (ARBs). These medications work by blocking the effects of a hormone called angiotensin II, which narrows blood vessels and increases blood pressure.

By inhibiting this hormone’s action, irbesartan helps blood vessels relax and widen, leading to a reduction in blood pressure. This mechanism of action makes irbesartan an effective treatment for hypertension, which is a significant risk factor for various cardiovascular diseases.

Is irbesartan a blood thinner?

No, irbesartan is not a blood thinner. While it affects the cardiovascular system by lowering blood pressure, it does not directly thin the blood or affect blood clotting processes. Blood thinners, such as warfarin or heparin, work differently by interfering with the blood’s ability to form clots.

Dosage and Administration of Irbesartan

The appropriate dosage of irbesartan varies depending on the individual patient’s needs and medical condition. Typically, the dosage ranges from 150mg to 300mg once daily. Here are some key points about irbesartan administration:

• Irbesartan is usually taken once a day, with or without food.
• The initial dose may be taken before bedtime to minimize the risk of dizziness.
• Patients over 75 years old or those with liver or kidney problems may require lower doses.
• It’s important to take irbesartan at the same time each day for consistent blood pressure control.

Doctors may adjust the dose based on blood pressure readings and the patient’s response to the medication. Regular follow-ups and blood tests are typically recommended to monitor kidney function and potassium levels.

Can the irbesartan dose be adjusted?

Yes, the dose of irbesartan can be adjusted. After initiating treatment, doctors often reassess the patient’s blood pressure and any side effects experienced. Based on these factors, they may increase or decrease the dose to achieve optimal blood pressure control while minimizing adverse effects.

Potential Side Effects and Precautions

Like all medications, irbesartan can cause side effects, although not everyone experiences them. Some common side effects include:

• Dizziness
• Fatigue
• Nausea
• Elevated potassium levels

Patients should be aware of more serious potential side effects, such as allergic reactions or significant changes in kidney function. It’s crucial to inform healthcare providers about any unusual symptoms or side effects experienced while taking irbesartan.

What should patients do if they experience severe diarrhea or vomiting while taking irbesartan?

If a patient experiences severe diarrhea or vomiting while taking irbesartan, they should contact their doctor or pharmacist immediately. These conditions can lead to dehydration and electrolyte imbalances, potentially affecting blood pressure and medication effectiveness. Healthcare providers may recommend temporarily stopping irbesartan until the patient recovers and can maintain normal fluid and food intake.

Missed Doses and Overdose Information

Adherence to the prescribed dosing schedule is important for maintaining consistent blood pressure control. However, if a dose is missed:

• Take the missed dose as soon as remembered, unless it’s almost time for the next scheduled dose.
• Do not double up on doses to make up for a missed one.
• If doses are frequently forgotten, consider setting reminders or using pill organizers.

In case of an overdose, immediate medical attention is necessary. Symptoms of irbesartan overdose may include severe dizziness, fainting, or abnormal heart rate.

How can patients prevent missing doses of irbesartan?

To prevent missing doses, patients can employ several strategies:

1. Set daily alarms on smartphones or other devices.
2. Use pill organizers to sort medications by day or time.
3. Associate taking the medication with a daily routine, such as brushing teeth.
4. Keep a medication log or use a mobile app to track doses.
5. Ask family members or caregivers for reminders if needed.

Recent Recalls of Irbesartan Products

In recent years, certain irbesartan products have been subject to recalls due to the presence of potential carcinogens. These recalls have raised concerns among patients and healthcare providers alike. The specific issue involves the detection of trace amounts of nitrosodiethylamine (NDEA), a probable carcinogen, in some batches of irbesartan.

For example, Prinston Pharmaceuticals recalled several lots of irbesartan and irbesartan HCTZ tablets due to unacceptable levels of NDEA. The affected products were manufactured using ingredients from Zhejiang Huahai Pharmaceuticals, a Chinese factory linked to multiple recalls of blood pressure medications.

Which specific irbesartan products were affected by the recall?

The recall affected various strengths and lot numbers of irbesartan and irbesartan HCTZ tablets. Some of the recalled products include:

• Irbesartan 300 mg, 90 count, lot number 331B18009
• Irbesartan HCTZ 300 mg/12.5 mg, 30 count, lot number 327A18001
• Irbesartan HCTZ 150 mg/12.5mg, 30 count, lot number 325D18004

Patients should check the FDA website or consult their pharmacist for a complete list of recalled medications.

Implications of the Irbesartan Recall for Patients

The recall of certain irbesartan products has significant implications for patients currently taking these medications. It’s important to understand the proper course of action if a prescribed medication is affected by the recall.

Should patients immediately stop taking recalled irbesartan products?

No, patients should not abruptly discontinue their irbesartan medication, even if it’s part of the recall. Stopping blood pressure medication suddenly can lead to a dangerous spike in blood pressure. Instead, patients should:

1. Check if their specific medication is included in the recall.
2. Contact their healthcare provider or pharmacist for guidance.
3. Continue taking the medication until a suitable alternative is provided.
4. Follow their doctor’s instructions for safely transitioning to a new medication if necessary.

Alternative Treatments and Future Considerations

In light of the recalls affecting some irbesartan products, healthcare providers may consider alternative treatments for managing high blood pressure. There are several other medications within the angiotensin II receptor blocker class, as well as other classes of antihypertensive drugs that can effectively control blood pressure.

Some alternatives to irbesartan include:

• Other ARBs: losartan, valsartan (those not affected by recalls), candesartan
• ACE inhibitors: lisinopril, enalapril
• Calcium channel blockers: amlodipine, nifedipine
• Diuretics: hydrochlorothiazide, chlorthalidone
• Beta-blockers: metoprolol, atenolol

How are pharmaceutical companies addressing the issue of contamination in blood pressure medications?

Pharmaceutical companies and regulatory agencies are taking several steps to address the contamination issues in blood pressure medications:

1. Implementing more rigorous testing protocols for raw materials and finished products.
2. Enhancing quality control measures in manufacturing processes.
3. Conducting thorough investigations into the root causes of contamination.
4. Exploring alternative manufacturing methods to reduce the risk of impurity formation.
5. Strengthening oversight of overseas manufacturing facilities.
6. Developing new guidelines for acceptable levels of potential contaminants in medications.

These efforts aim to ensure the safety and quality of blood pressure medications in the future.

The Importance of Ongoing Monitoring and Research

The recent recalls of irbesartan and other blood pressure medications highlight the need for continuous monitoring and research in pharmaceutical manufacturing and drug safety. Regulatory agencies, such as the FDA, play a crucial role in this process by:

• Conducting regular inspections of manufacturing facilities
• Reviewing and updating safety guidelines
• Investigating reports of adverse effects or quality issues
• Communicating important safety information to healthcare providers and the public

Ongoing research is also essential to improve our understanding of long-term effects of medications and to develop safer, more effective treatments for hypertension and other cardiovascular conditions.

How can patients stay informed about medication safety and recalls?

Patients can stay informed about medication safety and recalls through several methods:

1. Regularly check the FDA website for updates on drug recalls and safety alerts.
2. Sign up for email notifications from the FDA about medication recalls.
3. Maintain open communication with healthcare providers and pharmacists.
4. Keep track of medication lot numbers and expiration dates.
5. Stay informed through reputable health news sources.
6. Use medication tracking apps that may provide alerts about recalls.

By staying informed, patients can actively participate in their healthcare and make timely decisions about their medications.

Irbesartan: medicine to treat high blood pressure

Take irbesartan tablets once a day.

Your doctor may suggest that you take your first dose before bedtime, because it can make you dizzy. After the very first dose, you can take irbesartan at any time of day. Try to take it at the same time every day.

You can take irbesartan tablets with or without food. Swallow the tablets whole with a drink of water.

How much will I take?

The dose of irbesartan you take depends on why you need the medicine. Take it as instructed by your doctor.

The usual dose is 150mg to 300mg once a day.

If you are over 75, or you have liver or kidney problems, your dose may be lower.

Will my dose go up or down?

After a few weeks your doctor will check your blood pressure and ask you if you’re getting any side effects. You may also have blood tests to check how well your kidneys are working and the amount of potassium in your blood. Your doctor will then decide whether to change your dose of irbesartan.

If irbesartan doesn’t get your blood pressure down, your doctor may want to increase the dose. If your blood pressure gets too low or you get side effects, your doctor may want to lower your irbesartan dose.

What if I get sick while I’m taking it?

If you get severe diarrhoea or vomiting for any reason, contact your doctor or a pharmacist. They’ll be able to advise you about what to do.

They may recommend that you stop taking irbesartan until you’re better, and you’re able to eat and drink normally again.

What if I forget to take it?

If you miss a dose of irbesartan, take it as soon as you remember. Do not take a double dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

If you take too many irbesartan tablets by accident, contact your doctor or go to your nearest hospital straight away. An overdose of irbesartan can cause low blood pressure and changes in heart rate.

The amount of irbesartan that can lead to an overdose varies from person to person.

Irbesartan recalled for cancer risk

A drug company on Friday announced the recall of eight more lots of irbesartan blood pressure medication after testing revealed the drugs contained trace amounts of a carcinogen.

Prinston Pharmaceuticals recalled one lot of irbesartan tablets and seven lots of irbesartan HCTZ tablets. The medication contained unacceptable levels of the probable carcinogen nitrosodiethylamine, or NDEA, the company said. 

The drugs ingredients were made by Zhejiang Huahai Pharmaceuticals, a factory in China that has been linked to several recalls of commonly prescribed blood pressure drugs since July. The Food and Drug Administration has issued a warning letter and halted all new drug shipments from Zhejiang Huahai since uncovering a series of problems at the factory.

CLOSE

The Food and Drug Administration posted information on its website listing the blood pressure medications recalled for containing carcinogens. Here’s what to watch out for.

USA TODAY

Another factory in India, Hetero Labs Limited, also has been tied to multiple recalls.

The irbesartan recall is the latest involving a large class of blood pressure drugs called angiotensin II receptor blockers, which work by blocking the effects of a hormone that narrows blood vessels. Several versions of valsartan and losartan also have been recalled since July.

Many of these commonly prescribed drugs are not part of the recall. Consumers can check the FDA’s website for a full list of recalled drugs or ask their pharmacist.

More: Do you have high blood pressure? It depends on which doctor you ask

More: Blood pressure drug recall: FDA investigates foreign plants that made drugs with cancer-causing impurities

More: Three more blood pressure drugs recalled over cancer concern: Here’s what you need to know

More: More blood pressure medication recalled over carcinogen concerns — this time, losartan

Prinston advised patients to check with their doctor or pharmacist before they stop taking their medications.  Discontinuing a recalled drug could cause more immediate harm than staying on the medication.

Prinston said the following irbesartan and irbesartan hydrochlorothiazide tablets have been recalled:

• Irbesartan, 300 mg, 90 count, lot number 331B18009, expires February 2021

• Irbesartan HCTZ, 300 mg/12.5 mg, 30 count, lot number 327A18001, expires March 2021

• Irbesartan HCTZ, 300 mg/12.5 mg, lot number 327A18002, expires March 2021

• Irbesartan HCTZ, 300 mg/12.5 mg, 90 count, lot number 327B18008, expires March 2021 

• Irbesartan HCTZ, 300 mg/12.5 mg, 90 count, lot number 327B18009, expires March 2021

• Irbesartan HCTZ, 150 mg/12.5mg 30 count, lot number 325D18004, expires March 2021 

• Irbesartan HCTZ, 150 mg/12.5 mg, 90 count, lot number 325B18004, expires March 2021

• Irbesartan HCTZ, 150 mg /12.5 mg, 30 count, lot number 325D18005 expires March 2021 

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Irbesartan Drug Interactions – Drugs.com

1. Drugs A to Z
2. Irbesartan
3. Interactions

A total of 266 drugs are known to interact with
irbesartan.

• 28 major
  drug interactions
• 232 moderate
  drug interactions
• 6 minor
  drug interactions

View all medications that may interact with irbesartan.

Does irbesartan interact with my other drugs?

Enter other medications to view a detailed report.

Most frequently checked interactions

View interaction reports for irbesartan and the medicines listed below.

Irbesartan alcohol/food interactions

There is 1 alcohol/food interaction with irbesartan

Irbesartan disease interactions

There are 8 disease interactions with irbesartan which include:

More about irbesartan

Related treatment guides

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major	Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate	Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor	Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown	No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

4 Foods That Can Mess With Your Meds

What you eat and drink can cause harmful effects when mixed with certain drugs. Find out how to avoid these four common food-drug interactions.

Watch a short video overview below:

You probably know that you shouldn’t mix certain medications because of the risk of dangerous drug-drug interactions. And you’ve probably heard the common warnings to avoid taking some types of medication on an empty or full stomach or with alcohol.

But you may not be aware of food-drug interactions, which can occur when a medication interacts with a food or beverage and causes undesirable effects. The medication may not work as well as it should, or the combination can cause a negative side effect or worsen an existing one. Also, it may prevent your body from fully absorbing the nutrients from the food or beverage in question.

“There are different types of interactions, and the magnitude of the interaction depends on many factors,” says Lingtak-Neander Chan, PharmD, a professor of pharmacy at the University of Washington School of Pharmacy. For example, your age, sex, medical history, body weight, and number and dosage of medications used can all influence the way drugs and nutrients interact in your body.

“There is also a lot of misleading information out there on the Internet,” he notes.

We highlight four of the most common food-drug interactions, along with tips on how to avoid these combinations and the problems they can cause. However, you should always talk to your doctor if you are concerned about potential interactions with medications you are taking or plan to take.

High blood pressure/heart disease meds and potassium-rich foods like bananas, potatoes and licorice

More specifically, angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). ACE inhibitors include drugs like lisinopril, Altace (ramipril), Vasotec (enalapril) and captopril, while some examples of ARBs are Cozaar (losartan), Diovan (valsartan), Atacand (candesartan) and Micardis (telmisartan). These meds, which are used to treat high blood pressure and heart disease, make blood vessels relax and dilate, decrease the heart’s workload and improve circulation.

“These drugs have the tendency to increase potassium retention by the body, and elevated potassium concentration in the blood increases the risk for developing irregular heartbeats,” explains Chan. People taking ACE inhibitors or ARBs should limit their intake of high-potassium foods like bananas, oranges, avocados, tomatoes, white and sweet potatoes and dried fruits —, especially apricots.

On the other hand, natural licorice root contains a sweetening compound called glycyrrhizin, which can decrease potassium levels and throw off heart rhythms. According to the FDA, eating just two ounces of black licorice a day for at least two weeks could cause you to end up in the hospital with an irregular heart rhythm (arrhythmia), particularly if you’re 40 or older. Some people can experience abnormal heart rhythms, high blood pressure, swelling, lethargy and congestive heart failure.

However, if you’re eating this in conventional candy form, you likely have very little to worry about. According to the FDA, anise oil, which has a similar taste and smell, is used in many popular candies to mimic licorice flavor. Even candies that do have licorice extract fall far below levels the FDA considers dangerous. 

As with most foods, moderation is key for maintaining a healthy body. Whether as candy or in its natural root form, too much black licorice can bring about unwanted side effects. By limiting your intake, you can protect yourself against unwanted ailments. Additionally, FDA’s Linda Katz, M.D., M.P.H. says potassium levels are usually restored once consumption of the root stops, with no permanent health problems.

The FDA offers the following suggestions if black licorice is your guilty pleasure:

• Regardless of your age, avoid eating large amounts of black licorice at one time.
• If you have consumed a lot and have an irregular heart rhythm or muscle weakness, stop eating it immediately and contact your doctor.
• Black licorice can interact with some medications, herbs and dietary supplements. Be sure to contact your doctor if you have questions regarding possible drug interactions.

“Bottom line, too much or too little potassium in the blood can cause dangerous and life-threatening cardiac side effects,” says Lisa Cimperman, MS, RDN, LD, medical science liaison for Fresenius Kabi USA, which develops technologies for infusion, transfusion and clinical nutrition. Black licorice candy, licorice tea, and, of course, licorice root should be avoided while taking high blood pressure or heart disease drugs. And stay away from salt substitutes. Many have simply replaced the sodium with potassium.

Antibiotics & dairy products

Quinolone antibiotics like Cipro (ciprofloxacin), levofloxacin and Avelox (moxifloxacin), and tetracyclines like Vibramycin (doxycycline) and Minocin (minocycline), bind to the calcium in dairy-based foods and beverages.

“Dairy products and other calcium-rich products decrease the absorption of these antibiotics from the gut, which may lead to treatment failure for infections,” says Chan. In one study, the absorption of ciprofloxacin was reduced by up to 36% when participants took the drug at the same time as milk or yogurt. Other research found that even small amounts of milk that were added to coffee or black tea — containing very little calcium overall — had a major impact on the absorption of tetracycline.

You should take extra care to avoid the risk of minimizing the infection-fighting effects of the drug. Milk, cheese, ice cream, yogurt and butter, as well as calcium-fortified foods such as some juices and cereals, should not be taken while on these particular types of antibiotics. If for some reason these “cannot be avoided, separate the drug and dairy products by at least two hours,” Chan advises. (See MedShadow’s  5 Things You Need to Know About Antibiotics.

Calcium has also been shown to interfere with osteoporosis medications such as Fosamax (alendronate), thiazide diuretics for high blood pressure, cholesterol medications known as bile acid sequestrants and some anti-seizure medications such as Dilantin (phenytoin), Carbatrol (carbamazepine) and phenobarbital.

Statins & grapefruit…or maybe not

Eating grapefruit or having a glass of grapefruit juice in the morning can be a healthy way to start your day – the fruit is high in vitamin C and potassium. But the Food and Drug Administration (FDA) is reminding consumers that grapefruit can interact with many drugs and how they work in the body, especially if you have high blood pressure or an irregular heartbeat.

When grapefruit interacts with certain medications, the problem is that the juice causes too much of the drug to enter the bloodstream. That can lead to more side effects. For example, “with certain statins that lower ‘bad’ cholesterol levels, such as Zocor [simvastatin] [] and Lipitor [atorvastatin], it’s important to avoid grapefruit and grapefruit juice consumption because it can raise statin levels in the blood and increase the risk for serious side effects,” according to Stacy Kennedy, MPH, RD, a senior clinical nutritionist at the Dana-Farber/Brigham and Women’s Cancer Center in Boston and co-founder of Wellness Guides, a health and wellness practice in Wellesley, Massachusetts. . 

Grapefruit can increase absorption of the statins and lead to symptoms like dizziness, muscle pain, liver damage and kidney failure, adds Chan. 

Here are some types of drugs that may interact with grapefruit and grapefruit juice:

• Some drugs that treat high blood pressure, such as Procardia and Adalat CC (both nifedipine)
• Some organ-transplant rejection drugs, such as Sandimmune and Neoral (both cyclosporine)
• Some anti-anxiety drugs, such as buspirone
• Some corticosteroids that treat Crohn’s disease or ulcerative colitis, such as Entocort EC and Uceris (both budesonide)
• Some drugs that treat abnormal heart rhythms, such as Pacerone and Nexterone (both amiodarone)
• Some antihistamines, such as Allegra (fexofenadine)

For a further list of drugs that interact with grapefruit, click here. 

“There is no strong evidence showing ready-to-drink grapefruit juice or eating grapefruit results in the same magnitude of drug-nutrient interaction, though from the patient safety perspective, it is often recommended to patients who are taking these medications to avoid drinking grapefruit juice altogether,” Chan says.

If you eat grapefruit or drink grapefruit juice and have concerns about it interacting with any of the drugs you are taking, talk it over with your doctor. You can also read the medication guide or patient information sheet that comes with your prescription drugs to see if there is a grapefruit juice warning. For OTC (over-the-counter) drugs, check out the Drug Facts label on the bottle.

If you have to avoid grapefruit and grapefruit juice, pay attention to the labels of other fruit juices as they may contain grapefruit juice. Seville oranges, pomelos and tangelos can have the same effect on drugs as grapefruit, so best to avoid them if you know your drug can interact with grapefruit. Opt for other fruits like kiwi fruit, blood oranges and other fresh produce instead, suggests Kennedy.

Warfarin & vitamin K leafy greens

This anticoagulant — or blood-thinner — called Coumadin can help prevent dangerous blood clotting in patients with certain heart conditions. Because “vitamin K is important for numerous reactions that cause blood to clot properly, significant changes in vitamin K intake will affect the time it takes for blood to clot and likely require a change in warfarin dose,” according to Cimperman. 

It is not necessary or advisable to avoid vitamin K-rich foods altogether, however — just be consistent. The key is to “maintain a consistent and moderate day-to-day intake of vitamin K-rich foods such as broccoli, cabbage, collard greens, spinach, kale and turnip greens,” says Kennedy. Mango, avocado, cranberry juice or cranberry products can have similar effects, but “rather than avoid these heart-healthy foods completely, speak with your doctor before adding them so he or she can help you plan ahead and monitor your blood closely as you shift to a healthier diet,” she recommends.

Many patients who take warfarin may be at an increased risk of side effects of the drug since they are not knowledgeable about these food and drug interactions. The results of a study evaluating warfarin patients’ understanding of the drug and interactions are of concern since the side effects can lead to stroke and bleeding complications, which can sometimes be fatal.

“Worldwide, warfarin causes the most deaths from drug-related side effects,” senior author Kjersti Oterhald, PhD, of the Haukeland University Hospital in Norway said in a statement. “Patients need to know what foods and drugs have an impact on how warfarin works, and what to do if they have symptoms of an overdose.”

The study, presented at the EuroHeartCare 2016 Conference, which is sponsored by the European College of Cardiology, included results of a questionnaire that was sent to 404 patients with aortic stenosis who were taking warfarin. About two-thirds of them were taking the drug because they had a mechanical heart valve, and about a quarter was taking the medication to treat atrial fibrillation.  

They were given a questionnaire with 28 multiple choice questions about warfarin. On average, the participants answered 18 questions correctly. However, 22% only gave correct answers to fewer than half of the questions. Questions that were answered incorrectly tended to be about food and drug interactions and when to call a doctor. For example, when asked about which foods would interfere with warfarin — celery, carrots, coleslaw or green beans — only 25% correctly answered cole slaw. Most answered green beans. The survey also found that only 45% of respondents knew to go to a physician if they had diarrhea for more than one day. In addition, older patients tended to have more incorrect answers.

Oterhals noted that physicians and other healthcare workers need to better educate people taking warfarin about how the drug works inside the body to prevent any potentially serious interactions.

“Health professionals have a responsibility to educate patients, but unfortunately, even cardiac nurses do not know enough,” she noted. “There is an urgent need to improve health professionals’ warfarin knowledge so they can educate patients.”

WARFARIN CHECKLIST

• Diet: Keep vitamin K intake consistent and check the content of new foods; even small levels eaten in large amounts affect the INR (International Normalized Ratio — a blood test that measures how long it takes a person’s blood to clot).
• Drugs: Antibiotics increase INR; avoid herbal medicines; ask about over the counter drugs.
• Call the doctor: Nosebleeds indicate blood is too thin; diarrhea causes vitamin K loss.
• Exercise: Patients who exercise regularly need a higher warfarin dose.
• Be consistent: Check how anything out of the ordinary will affect your warfarin.

Courtesy European College of Cardiology

Talk to Your Doc to Balance Your Diet & Your Meds

Consider this a general primer to help alert you to some common potential effects of mixing certain foods and medications, but be sure to learn what’s best for you by talking to your healthcare providers.

“It is imperative that individuals discuss all their medications and supplements with their physician and pharmacist,” says Cimperman. “In the case where there is a significant food-drug interaction, consult with a registered dietitian to make sure your diet is nutritionally complete while avoiding problematic foods.”

Sandoz Irbesartan – Uses, Side Effects, Interactions

How does this medication work? What will it do for me?

Irbesartan belongs to a family of medicines known as angiotensin II receptor blockers. These medicines are used to lower high blood pressure and work by relaxing blood vessels. Irbesartan is also used to lower blood pressure and decrease the rate of the progression of kidney damage in patients with type 2 diabetes.

Angiotensin II is a chemical that the body releases to cause the constriction of blood vessels. Irbesartan blocks the action of angiotensin II, resulting in the relaxation of the blood vessels. This relaxation causes the blood pressure to decrease. The full effects of irbesartan are usually seen within about 4 weeks. It can be used alone or in combination with thiazide diuretics (water pills; e.g., hydrochlorothiazide).

This medication does not cure high blood pressure, but it does help to control it, when it is taken regularly. Do not stop taking this medication without discussing the risks and benefits with your doctor.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

75 mg
Each white, oval, biconvex, film-coated tablet, debossed with “75” on one side contains 75 mg of irbesartan. Nonmedicinal ingredients: cellulose microcrystalline, croscarmellose sodium, hypromellose, lactose monohydrate, hydroxypropylcellulose, magnesium stearate, polyethylene glycol, silica colloidal anhydrous, talc, and titanium dioxide.

150 mg
Each white, oval, biconvex, film-coated tablet, debossed with “150” on one side and a score line on the other side, contains 150 mg of irbesartan. Nonmedicinal ingredients: cellulose microcrystalline, croscarmellose sodium, hypromellose, lactose monohydrate, hydroxypropylcellulose, magnesium stearate, polyethylene glycol, silica colloidal anhydrous, talc, and titanium dioxide.

300 mg
Each white, oval, biconvex, film-coated tablet, debossed with “300” on one side and a score line on the other side, contains 300 mg of irbesartan. Nonmedicinal ingredients: cellulose microcrystalline, croscarmellose sodium, hypromellose, lactose monohydrate, hydroxypropylcellulose, magnesium stearate, polyethylene glycol, silica colloidal anhydrous, talc, and titanium dioxide.

How should I use this medication?

The usual starting dose of irbesartan is 150 mg daily at approximately the same time each day. If you are taking other medication to reduce your blood pressure, your doctor may start you with a dose of 75 mg daily. The doctor may decide to increase the dose to 300 mg once a day if your blood pressure has not come down enough.

Irbesartan may be taken with or without food but should be taken in the same manner each day.

Make sure you follow your doctor’s instructions about monitoring your blood pressure to ensure that you receive the maximum benefit from the medication.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take irbesartan if you:

• are allergic to irbesartan or any ingredients of the medication
• have experienced a serious allergic reaction to another angiotensin II receptor blocker (ARB) (e.g., candesartan, losartan, valsartan)
• have diabetes mellitus, kidney damage caused by diabetes, or severely reduced kidney function and are taking the medication aliskiren or an angiotensin-converting enzyme (ACE) inhibitor
• are pregnant
• are breast-feeding
• have galactose intolerance or glucose malabsorption (a rare hereditary disease)










What side effects are possible with this medication?




Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• diarrhea
• dizziness
• headache
• lightheadedness
• rash
• trouble sleeping
• unusual tiredness

Although most of these side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• back leg muscle cramps
• dark brown urine
• dizziness when rising from a sitting or lying position
• fainting
• muscle pain, tenderness, or weakness
• ringing in the ears
• signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don’t stop bleeding)
• signs of kidney problems (e.g., increased urination at night, decreased urine production, blood in the urine)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• signs of too much potassium in the blood (e.g., muscle weakness, irregular heartbeat, general feeling of being unwell)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of a serious allergic reaction (e. g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.









Are there any other precautions or warnings for this medication?




Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Drowsiness/reduced alertness: Irbesartan, like other medications for blood pressure may cause dizziness and lightheadedness, especially if you have been taking a diuretic (water pill). This may affect your ability to drive or operate machinery. Avoid these and other activities until you have determined that this medication does not affect you in this way.

Heart disease: If you have a history of heart problems, such as a recent heart attack or stroke, narrowing of the heart valves (valvular stenosis) or other heart disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: Irbesartan may affect the function of the kidneys, especially for people who already have kidney problems. Certain people may be more likely to experience changes in kidney function (e.g., people with narrowed blood vessels in their kidneys, or those with severe congestive heart failure). The use of diuretics (water pills) or aliskiren may further increase risk of kidney problems for those at risk for this problem. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Low blood pressure: Occasionally, a larger-than-expected decrease in blood pressure occurs after taking irbesartan. In some cases, this happens after the first dose. It is more likely to occur if you take diuretics (water pills) or the medication aliskiren, have a reduced salt intake, are on dialysis, or are experiencing diarrhea or vomiting. Blood pressure should be monitored more often in these situations. If you have low blood pressure or are just starting to take this medication, move slowly from a reclining to an upright position to reduce the risk of dizziness.

Potassium levels: This medication may affect potassium levels in the blood, especially when used for heart failure, or when taken with other medications called ACE inhibitors or diuretics such as spironolactone. Your doctor will monitor your potassium levels while you are on this medication. Avoid using salt substitutes that contain potassium while you are taking irbesartan.

Pregnancy: Irbesartan can cause severe harm or death to a developing baby if it is taken by the mother during pregnancy. Therefore, this medication should not be taken by pregnant women. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if irbesartan passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

Seniors: Older adults may be more likely to experience side effects of this medication.







What other drugs could interact with this medication?




There may be an interaction between irbesartan and any of the following:

• aliskiren
• alpha agonists (e.g., clonidine, methyldopa)
• alpha blockers (e.g., alfuzosin, doxazosin, tamsulosin)
• amifostine
• amiodarone
• amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
• angiotensin converting enzyme (ACE) inhibitors (e.g., captopril, ramipril, enalapril)
• antipsychotics (e.g., aripiprazole, clozapine, olanzapine, pimozide) beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
• bosentan
• brimonidine
• calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
• canagliflozin
• celecoxib
• ciprofloxacin
• cyclosporine
• dapsone
• dasabuvir
• dipyridamole
• diuretics (water pills; e.g., hydrochlorothiazide, furosemide)
• enzalutamide
• fluconazole
• ginger
• guanfacine
• ginseng (American)
• heparin
• hydralazine
• isosorbide dinitrate or isosorbide mononitrate
• lithium
• lomitapide
• low molecular weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
• methylphenidate
• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
• nonsteroidal anti-inflammatory medications (e. g., diclofenac, ibuprofen, ketoprofen, naproxen)
• other angiotensin receptor blockers (ARBs; e.g., candesartan, losartan)
• paclitaxel
• pentoxifylline
• phenobarbital
• phenytoin
• phosphodiesterase 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
• pioglitazone
• potassium pills or potassium supplements
• potassium-sparing diuretics (e.g., amiloride, spironolactone, triamterene)
• quinine
• repaglinide
• rifabutin
• rifampin
• rituximab
• rosiglitazone
• sacubitril
• salt substitutes that contain potassium
• sodium phosphates
• sulfonamide anti-diabetes medications (e.g., chlorpropamide, gliclazide, glyburide)
• sulfonamide antibiotics (e.g., sulfamethoxazole, sulfisoxazole)
• tamoxifen
• tolvaptan
• trimethoprim
• tretinoin
• warfarin
• yohimbine
• zafirlukast

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Sandoz-Irbesartan

Types of Heart Medications | American Heart Association

If you’ve had a heart attack, you will most likely be prescribed medication that you will take for the rest of your life.

There are many types and combinations of drugs used to treat coronary artery disease (CAD), and your doctor or other health care provider will decide the best treatment combination for your situation.

The following gives you a quick look at many typical cardiac medications. Your prescription may have a different name from the ones listed on this chart. Brand names commonly available in the U.S. are shown in parentheses after the generic name for each drug.

*Some of the major types of commonly prescribed cardiovascular medications are summarized in this section. For your information and reference, we have included generic names as well as major trade names to help you identify what you may be taking. However, the AHA is not recommending or endorsing any specific products. If your prescription medication isn’t on this list, remember that your healthcare provider and pharmacist are your best sources of information. It’s important to discuss all of the drugs you take with your provider and understand their desired effects and possible side effects. Never stop taking a medication and never change your dose or frequency without first consulting the prescribing doctor.

Anticoagulants

(Also known as Blood Thinners.)

Commonly prescribed include:

• Apixaban (Eliquis) 
• Dabigatran (Pradaxa)
• Edoxaban (Savaysa)
• Heparin (various)
• Rivaroxaban (Xarelto)
• Warfarin (Coumadin)

What the Medication Does

Decreases the clotting (coagulating) ability of the blood. Sometimes called blood thinners, although they do not actually thin the blood. They do NOT dissolve existing blood clots. Used to treat certain blood vessel, heart and lung conditions.

Reason for Medication

• Helps to prevent harmful clots from forming in the blood vessels.
• May prevent the clots from becoming larger and causing more serious problems.
• Often prescribed to prevent first or recurrent stroke.

Antiplatelet Agents and Dual Antiplatelet Therapy (DAPT)

Commonly prescribed include:

• Aspirin
• Clopidogrel (Plavix)
• Dipyridamole (Persantine)
• Prasugrel (Effient)
• Ticagrelor (Brilinta)

What the Medication Does

Keeps blood clots from forming by preventing blood platelets from sticking together.

Reason for Medication

• Helps prevent clotting in patients who have had a heart attack, unstable angina, ischemic strokes, TIA (transient ischemic attacks) and other forms of cardiovascular disease.
• Can also be prescribed preventively when plaque buildup is evident but there is not yet a major blockage in the artery.
• Certain patients will be prescribed aspirin combined with another antiplatelet drug – also known as dual antiplatelet therapy (DAPT). 

Dual Antiplatelet Therapy (DAPT)

Some patients who have heart attacks, that have stents placed in their coronary arteries, or undergo coronary artery bypass graft surgery (CABG) are treated with two types of antiplatelet agents at the same time to prevent blood clotting. This is called dual antiplatelet therapy (DAPT).

One antiplatelet agent is aspirin. Almost everyone with coronary artery disease, including those who have had a heart attack, stent, or CABG are treated with aspirin for the rest of their lives. A second type of antiplatelet agent, called a P2Y₁₂ inhibitor, is usually prescribed for months or years in addition to the aspirin therapy.

The type of medication and the duration of your treatment will vary based on your condition and other risk factors. The risks and benefits of DAPT should be discussed with your health care provider.

• If you did not have a heart attack, but have atherosclerosis in your coronary arteries and had a stent placed, in addition to aspirin, you should be on clopidogrel for at least 1-6 months, depending on the type of stent which was placed, risk of clotting the stent, and bleeding risk. 
• If you had a heart attack and a coronary artery stent placed, or you are being treated with medical therapy (no stent, clot buster or surgery), in addition to aspirin, you should also be on a P2Y₁₂ inhibitor for 6-12 months. In some cases, it may be advisable to be on DAPT longer. This will need to be discussed with your healthcare provider. The three P2Y₁₂ inhibitors currently available that could be prescribed are clopidogrel, prasugrel, and ticagrelor. Studies have shown that two of these drugs (ticagrelor, prasugrel) are “stronger” than clopidogrel, and are a little better at decreasing the complications of blood clots. These two stronger agents, however, slightly increase bleeding. One of these drugs (prasugrel) should not be used by patients who have had a stroke or a transient ischemic attack (TIA). You will be prescribed the drug that is best for you, based on your risk of blood clots and bleeding. For example, according to the FDA(link opens in new window), clopidogrel does decrease the risk of stroke and MI, but does not change the risk of death for specific patients. The choice of what type of medication, cost of the medication and duration of treatment will be determined in discussions with your health care provider.
• Some patients who undergo coronary artery bypass surgery may be treated with a P2Y₁₂ inhibitor for a year after the bypass operation. After this, the P2Y₁₂ inhibitor might be stopped, but aspirin is usually continued long-term. Your surgeon will discuss if this treatment will be needed.

These are general recommendations for the duration and type of dual anti-platelet therapy which could be used after coronary artery stenting, heart attack and CABG. Again, it is important to talk to your health care provider about your treatment plan.

Print a patient information sheet on DAPT (PDF).

Angiotensin-Converting Enzyme (ACE) Inhibitors

Commonly prescribed include:

• Benazepril (Lotensin)
• Captopril (Capoten)
• Enalapril (Vasotec)
• Fosinopril (Monopril)
• Lisinopril (Prinivil, Zestril)
• Moexipril (Univasc)
• Perindopril (Aceon)
• Quinapril (Accupril)
• Ramipril (Altace)
• Trandolapril (Mavik) 

What the Medication Does

Expands blood vessels and decreases resistance by lowering levels of angiotensin II. Allows blood to flow more easily and makes the heart’s work easier or more efficient.

Reason for Medication

Angiotensin II Receptor Blockers (or Inhibitors)

(Also known as ARBs)

Commonly prescribed include:

• Azilsartan (Edarbi)
• Candesartan (Atacand)
• Eprosartan (Teveten)
• Irbesartan (Avapro)
• Losartan (Cozaar)
• Olmesartan (Benicar) 
• Telmisartan (Micardis) 
• Valsartan (Diovan) 

What the Medication Does

Rather than lowering levels of angiotensin II (as ACE inhibitors do) angiotensin II receptor blockers prevent this chemical from having any effect on the heart and blood vessels. This keeps blood pressure from rising.

Reason for Medication

• Used to treat or improve symptoms of cardiovascular conditions including high blood pressure and heart failure.

Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)

ARNIs are a drug combination of a neprilysin inhibitor and an ARB.

Commonly prescribed include:

• Sacubitril/valsartan (Entresto)

What the Medication Does

Neprilysin is an enzyme that breaks down natural substances in the body that open narrowed arteries. By limiting the effect of neprilysin, it increases the effects of these substances and improves artery opening and blood flow, reduces sodium (salt) retention, and decreases strain on the heart.

Reason for Medication

• For the treatment of heart failure

Beta Blockers

(Also known as Beta-Adrenergic Blocking Agents)

Commonly prescribed include:

• Acebutolol (Sectral)
• Atenolol (Tenormin)
• Betaxolol (Kerlone)
• Bisoprolol/hydrochlorothiazide (Ziac)
• Bisoprolol (Zebeta)
• Metoprolol (Lopressor, Toprol XL)
• Nadolol (Corgard)
• Propranolol (Inderal)
• Sotalol (Betapace)

What the Medication Does

Decreases the heart rate and force of contraction, which lowers blood pressure and makes the heart beat more slowly and with less force.

Reason for Medication

• Used to lower blood pressure.
• Used for cardiac arrhythmias (abnormal heart rhythms)
• Used to treat chest pain (angina)
• Used to help prevent future heart attacks in patients who have had a heart attack.

Combined Alpha and Beta-Blockers

Combined alpha and beta-blockers are used to treat high blood pressure and heart failure.

Commonly prescribed include:

• Carvedilol (Coreg, Coreg CR)
• Labetalol hydrochloride (Normodyne, Trandate)

A noted possible side effect of combined alpha and beta-blockers:

• May cause a drop in blood pressure when you stand up

Calcium Channel Blockers

(Also known as Calcium Antagonists or Calcium Blockers)

Commonly prescribed include:

• Amlodipine (Norvasc)
• Diltiazem (Cardizem, Tiazac)
• Felodipine (Plendil)
• Nifedipine (Adalat, Procardia)
• Nimodipine (Nimotop)
• Nisoldipine (Sular)
• Verapamil (Calan, Verelan)

What the Medication Does

Interrupts the movement of calcium into the cells of the heart and blood vessels. May decrease the heart’s pumping strength and relax blood vessels.

Reason for Medication

• Used to treat high blood pressure, chest pain (angina) caused by reduced blood supply to the heart muscle and some arrhythmias (abnormal heart rhythms).

Cholesterol-Lowering Medications

• Statins: Atorvastatin (Lipitor), Fluvastatin (Lescol), Lovastatin (Mevacor), Pitavastatin (Livalo), Pravastatin (Pravachol), Rosuvastatin (Crestor), Simvastatin (Zocor)
• Nicotinic acids: Niacin
• Cholesterol absorption inhibitor: Ezetimibe (Zetia)
• Combination statin and cholesterol absorption inhibitors: Ezetimibe/Simvastatin (Vytorin)

What the Medication Does

Various medications can lower blood cholesterol levels, but drugs other than statins are usually only used for patients in whom statins are not effective or who have serious side effects from statin therapy. They work in the body in different ways. Some affect the liver, some work in the intestines and some interrupt the formation of cholesterol from circulating in the blood. Watch an animation of how statins work.

Reason for Medication

Used to lower LDL (“bad”) cholesterol.

*Some cholesterol-lowering medications may interact with grapefruit, grapefruit juice, pomegranate and pomegranate juice. Please talk to your health care provider about any potential risks. 

Digitalis Preparations 

Commonly prescribed include:

What the Medication Does

Increases the force of the heart’s contractions. Can be beneficial in treating heart failure and irregular heartbeats.

Reason for Medication

• Used to relieve heart failure symptoms, especially when the patient isn’t responding to other standard treatments including ACE inhibitors, ARBs and diuretics.
• Also slows certain types of irregular heartbeat (arrhythmias), particularly atrial fibrillation.

Diuretics

(Also known as Water Pills)

Commonly prescribed include:

• Acetazolamide (Diamox)
• Amiloride (Midamor)
• Bumetanide (Bumex)
• Chlorothiazide (Diuril)
• Chlorthalidone (Hygroton)
• Furosemide (Lasix)
• Hydro-chlorothiazide (Esidrix, Hydrodiuril)
• Indapamide (Lozol) 
• Metalozone (Zaroxolyn)
• Spironolactone (Aldactone)
• Torsemide (Demadex)

What the Medication Does

Causes the body to rid itself of excess fluids and sodium through urination. Helps to reduce the heart’s workload. Also decreases the buildup of fluid in the lungs and other parts of the body, such as the ankles and legs. Different diuretics remove fluid at varied rates and through different methods.

Reason for Medication

• Used to help lower blood pressure.
• Used to help reduce swelling (edema) from excess buildup of fluid in the body.

Vasodilators

Commonly prescribed include:

• Isosorbide dinitrate (Isordil)
• Isosorbide mononitrate (Imdur)
• Hydralazine (Apresoline)
• Nitroglycerin (Nitro Bid, Nitro Stat)
• Minoxidil

What the Medication Does

Relaxes blood vessels and decreases blood pressure. 

A category of vasodilators called nitrates increases the supply of blood and oxygen to the heart while reducing its workload which can ease chest pain (angina). Nitroglycerin is available as a pill to be swallowed or absorbed under the tongue (sublingual), a spray, and as a topical application (cream).

Reason for Medication

Aprovel 150mg film-coated tablets – Patient Information Leaflet (PIL)

APROVEL^® 150 mg film-coated tablets

irbesartan

• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

1. What Aprovel is and what it is used for

2. What you need to know before you take Aprovel

3. How to take Aprovel

4. Possible side effects

5. How to store Aprovel

6. Contents of the pack and other information

Aprovel belongs to a group of medicines known as angiotensin-II receptor antagonists. Angiotensin-II is a substance produced in the body which binds to receptors in blood vessels causing them to tighten. This results in an increase in blood pressure. Aprovel prevents the binding of angiotensin-II to these receptors, causing the blood vessels to relax and the blood pressure to lower. Aprovel slows the decrease of kidney function in patients with high blood pressure and type 2 diabetes.

Aprovel is used in adult patients

• to treat high blood pressure (essential hypertension)
• to protect the kidney in patients with high blood pressure, type 2 diabetes and laboratory evidence of impaired kidney function.

• if you are allergic to irbesartan or any other ingredients of this medicine (listed in section 6)
• if you are more than 3 months pregnant. (It is also better to avoid Aprovel in early pregnancy – see pregnancy section)
• if you have diabetes or impaired kidney function and you are treated with a blood pressure lowering medicine containing aliskiren.

Talk to your doctor before taking Aprovel and if any of the following apply to you:

• if you get excessive vomiting or diarrhea
• if you suffer from kidney problems
• if you suffer from heart problems
• if you receive Aprovel for diabetic kidney disease. In this case your doctor may perform regular blood tests, especially for measuring blood potassium levels in case of poor kidney function
• if you are going to have an operation (surgery) or be given anaesthetics
• if you are taking any of the following medicines used to treat high blood pressure:
  
  • an ACE-inhibitor (for example enalapril, lisinopril, ramipril) in particular if you have diabetes-related kidney problems.
  • aliskiren

Your doctor may check your kidney function, blood pressure, and the amount of electrolytes (e.g. potassium) in your blood at regular intervals.

See also information under the heading “Do not take Aprovel”.

You must tell your doctor if you think you are (or might become) pregnant. Aprovel is not recommended in early pregnancy, and must not be taken if you are more than 3 months pregnant, as it may cause serious harm to your baby if used at that stage (see pregnancy section).

This medicinal product should not be used in children and adolescents because the safety and efficacy have not yet been fully established.

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

Your doctor may need to change your dose and/or to take other precautions:

If you are taking an ACE-inhibitor or aliskiren (see also information under the headings “Do not take Aprovel” and “Warnings and precautions”).

• potassium supplements
• salt substitutes containing potassium
• potassium-sparing medicines (such as certain diuretics)
• medicines containing lithium

If you take certain painkillers, called non-steroidal anti-inflammatory drugs, the effect of irbesartan may be reduced.

Aprovel can be taken with or without food.

Pregnancy

You must tell your doctor if you think you are (or might become) pregnant. Your doctor will normally advise you to stop taking Aprovel before you become pregnant or as soon as you know you are pregnant and will advise you to take another medicine instead of Aprovel. Aprovel is not recommended in early pregnancy, and must not be taken when more than 3 months pregnant, as it may cause serious harm to your baby if used after the third month of pregnancy.

Breast-feeding

Tell your doctor if you are breast-feeding or about to start breast-feeding. Aprovel is not recommended for mothers who are breast-feeding, and your doctor may choose another treatment for you if you wish to breast-feed, especially if your baby is newborn, or was born prematurely.

Aprovel is unlikely to affect your ability to drive or use machines. However, occasionally dizziness or weariness may occur during treatment of high blood pressure. If you experience these, talk to your doctor before attempting to drive or use machines.

Aprovel contains lactose. If you have been told by your doctor that you have an intolerance to some sugars (e.g. lactose), contact your doctor before taking this medicinal product.

Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.

Aprovel is for oral use. Swallow the tablets with a sufficient amount of fluid (e.g. one glass of water). You can take Aprovel with or without food. Try to take your daily dose at about the same time each day. It is important that you continue to take Aprovel until your doctor tells you otherwise.

• Patients with high blood pressure
  
  The usual dose is 150 mg once a day. The dose may later be increased to 300 mg (two tablets a day) once daily depending on blood pressure response.
• Patients with high blood pressure and type 2 diabetes with kidney disease
  
  In patients with high blood pressure and type 2 diabetes, 300 mg (two tablets a day) once daily is the preferred maintenance dose for the treatment of associated kidney disease.

The doctor may advise a lower dose, especially when starting treatment in certain patients such as those on haemodialysis, or those over the age of 75 years.

The maximal blood pressure lowering effect should be reached 4-6 weeks after beginning treatment.

Aprovel should not be given to children under 18 years of age. If a child swallows some tablets, contact your doctor immediately.

If you accidentally take too many tablets, contact your doctor immediately.

If you accidentally miss a daily dose, just take the next dose as normal. Do not take a double dose to make up for a forgotten dose.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Some of these effects may be serious and may require medical attention.

As with similar medicines, rare cases of allergic skin reactions (rash, urticaria), as well as localised swelling of the face, lips and/or tongue have been reported in patients taking irbesartan. If you get any of these symptoms or get short of breath, stop taking Aprovel and contact your doctor immediately.

The frequency of the side effects listed below is defined using the following convention:

Very common: may affect more than 1 in 10 people

Common: may affect up to 1 in 10 people

Uncommon: may affect up to 1 in 100 people

Side effects reported in clinical studies for patients treated with Aprovel were:

• Very common (may affect more than 1 in 10 people): if you suffer from high blood pressure and type 2 diabetes with kidney disease, blood tests may show an increased level of potassium.
• Common (may affect up to 1 in 10 people): dizziness, feeling sick/vomiting, fatigue and blood tests may show raised levels of an enzyme that measures the muscle and heart function (creatine kinase enzyme). In patients with high blood pressure and type 2 diabetes with kidney disease, dizziness when getting up from a lying or sitting position, low blood pressure when getting up from a lying or sitting position, pain in joints or muscles and decreased levels of a protein in the red blood cells (haemoglobin) were also reported.
• Uncommon (may affect up to 1 in 100 people): heart rate increased, flushing, cough, diarrhoea, indigestion/heartburn, sexual dysfunction (problems with sexual performance), chest pain.

Some undesirable effects have been reported since marketing of Aprovel. Undesirable effects where the frequency is not known are: feeling of spinning, headache, taste disturbance, ringing in the ears, muscle cramps, pain in joints and muscles, reduced number of platelets, abnormal liver function, increased blood potassium levels, impaired kidney function, inflammation of small blood vessels mainly affecting the skin (a condition known as leukocytoclastic vasculitis), and severe allergic reactions (anaphylactic shock). Uncommon cases of jaundice (yellowing of the skin and/or whites of the eyes) have also been reported.

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet.

United Kingdom

You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

Ireland

You can also report side effects directly via

HPRA Pharmacovigilance
Earlsfort Terrace
IRL – Dublin 2

Tel: +353 1 6764971

Fax: +353 1 6762517

Website: www.hpra.ie

By reporting side effects you can help provide more information on the safety of this medicine.

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the carton and on the blister after EXP. The expiry date refers to the last day of that month.

Do not store above 30°C.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

• The active substance is irbesartan. Each tablet of Aprovel 150 mg contains 150 mg irbesartan.
• The other ingredients are lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, hypromellose, silicon dioxide, magnesium stearate, titanium dioxide, macrogol 3000, carnauba wax. Please see section 2 “Aprovel contains lactose”.

Aprovel 150 mg film-coated tablets are white to off-white, biconvex, and oval-shaped with a heart debossed on one side and the number 2872 engraved on the other side.

Aprovel 150 mg film-coated tablets are supplied in blister packs of 14, 28, 30, 56, 84, 90 or 98 film-coated tablets. Unidose blister packs of 56 x 1 film-coated tablet for delivery in hospitals are also available.

Not all pack sizes may be marketed.

sanofi-aventis groupe
54, rue La Boétie
F-75008 Paris
France

SANOFI-AVENTIS, S.A.
Ctra, C-35 (La Batlloria-Hostalric)
km. 63.09
17404 Riells i Viabrea (Girona)
Spain

This leaflet was last revised in 11/2019

Detailed information on this medicine is available on the European Medicines Agency web site: http://www.ema.europa.eu/

For any information about this medicinal product, please contact the local representative of the Marketing Authorisation Holder.

United Kingdom

Sanofi

Tel: +44 (0) 845 372 7101

Ireland

sanofi-aventis Ireland Ltd.
T/A SANOFI

Tel: +353 (0) 1 403 56 00

764346

90,000 Heart Failure Medicines – Heart Failure Medicine

Taking medication is a key part of the treatment of heart failure. The goal is to eliminate the cause of the heart failure so that the condition does not get worse. Drugs can also ease your symptoms and improve your quality of life.

This means you may need more than one medicine for heart failure, and each medicine will have its own set of instructions on how to take it correctly.Each also has its own risks of side effects. Make sure your doctor explains why you need each drug and what you should expect when taking it.

Types of drugs for heart failure

The right heart failure medicine for you depends on factors such as:

• How well do you respond to treatment?

• Have you had a negative reaction to any medications

• The type of heart failure you have

• The severity of your condition

Based on this, your doctor may prescribe one or more of the following medicines for heart failure.

Drugs to reduce the burden on the heart

• ACE inhibitors (angiotensin converting enzyme) : lowering blood pressure. This allows the blood to flow more easily, so the heart doesn’t have to work as hard. Common ACE inhibitors include benazepril (Lotenzin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), and lisinopril (Prinivil, Zestril).

• ARBs (angiotensin II receptor blockers) : Relax blood vessels and lower blood pressure differently than ACE inhibitors.Common ARBs include candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), and losartan (Cozaar).

• ARNIs (Neprilisin Angiotensin Receptor Inhibitors) : Neprilisin is an enzyme that breaks down substances in the body that help dilate narrowed arteries. ARNI are combination drugs that contain ARB and an inhibitor that limits the effect of this enzyme. By inhibiting neprilisin, taking this drug can improve blood flow and reduce stress on the heart.A common ARNI is sacubitril / valsartan (Entresto).

• Beta Blockers : Lower your blood pressure and make your heart beat slower and less forcefully. These effects can help ease the strain on the heart. Common beta blockers include acebutolol (Sectral), atenolol (Tenormin), betaxolol (Kerlone), bisoprolol / hydrochlorothiazide (Ziac), bisoprolol (Zebeta), and metoprolol (Lopressor, Toprol-XL).

• Calcium channel blockers : block the movement of calcium into the heart and blood vessels.It helps to relax the blood vessels and reduce the pumping power of the heart. Common calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem, Tiazac), felodipine (Plendil), and nifedipine (Adalat, Procardia).

• Vasodilators : Help relax blood vessels and ease the work of the heart. They work by increasing the supply of blood and oxygen to the heart. Common vasodilators include isosorbide dinitrate (isordil), hydralazine (apresolin), and minoxidil.

Drugs help the heart pump more blood

Heart failure develops over time. The heart becomes weaker and less able to pump blood. Digitalis is used as a medicine for heart failure because it helps the heart beat faster. This allows the heart to supply more blood to the body. A common remedy for digitalis is digoxin (lanoxin).

Drugs for lowering cholesterol levels

The main causes of heart failure are conditions that damage the heart, such as high blood pressure and coronary artery disease.The higher the blood cholesterol level, the higher the risk of heart disease and heart attack. Your doctor may prescribe a cholesterol-lowering drug to prevent more damage to your heart.

Several drugs can help lower low-density lipoprotein (LDL) cholesterol levels. This is the so-called “bad” cholesterol. Each drug works differently. Most people take statins, such as atorvastatin (Lipitor) or rosuvastatin (Crestor). If one statin doesn’t work for you, other options include a statin in combination with another medication.For example, a statin / niacin combination (Advicor) or a statin combined with a cholesterol absorption inhibitor (Vytorin).

Preparations to reduce the accumulation of fluid in the body

If the heart loses its pumping power, blood can accumulate in the veins. This can lead to accumulation of fluid inside the body. Your legs, feet, and ankles may swell. Fluid can also enter the liver, gastrointestinal tract, and abdomen. Sometimes fluid builds up in the lungs, causing breathing problems.You can take medication to reduce the buildup.

• Aldosterone Receptor Antagonists : Block the action of hormones that help regulate sodium levels in the body. They can prevent heart failure from getting worse by changing the amount of sodium you lose in your urine. Like diuretics, they help to flush out excess fluid in the body and lower blood pressure. Common aldosterone receptor antagonists include spironolactone (aldactone) and eplerenone (inspra).

• Diuretics : helps to get rid of excess fluid in the body. Removing the extra fluid will lower your blood pressure and should help you breathe better. It will also reduce swelling in the feet and ankles. Common diuretics include amiloride (Midamor), bumetanide (Bumex), chlorothiazide (Diuril), chlorthalidone (Hygroton), furosemide (Lasix), and hydrochlorothiazide (Esidrix, Hydrodiuril).

Preparations for the prevention of blood clots

• Antiplatelet drugs .These medications can also help reduce the risk of blood clots. They work by preventing platelets from clumping together, forming clots. They are often prescribed for people with plaque buildup in their arteries. Common antiplatelet agents include aspirin, clopidogrel (Plavix), and dipyridamole.

• Blood thinners (anticoagulants) : Heart failure can cause abnormal blood clotting. Your doctor may give you a blood thinner to prevent this from happening.Despite their name, blood thinners don’t actually thin the blood or dissolve blood clots. They work to prevent blood clotting. Some common blood thinners include apixaban (Eliquis), heparin injection, rivaroxaban (Xarelto), and warfarin (Coumadin).

90 027 90 000 💊 Symptoms and signs of blood clots (leg, lung) and pictures

Blood clot facts

• Blood clots are usually formed as a normal function of blood cells to repair damaged blood vessel walls.Blood clots become a problem when blood “clots” in an artery or vein improperly prevent blood from flowing through those blood vessels
• Risk factors for blood clots in the arteries include high blood pressure, high cholesterol, diabetes, smoking, and a family history of blood clots.
• Risk factors for developing blood clots in the veins include prolonged immobility (including immobility after surgery), hormonal therapy (including birth control pills), smoking, pregnancy, and genetic factors.
• Causes of arterial clot formation include ruptured atherosclerotic plaques, as in a heart attack. A clot embolism can block (occlude) an artery after it travels from one part of the body to another, such as a stroke from a blood clot that occurs in the heart.
• Causes of venous blood stains include immobility, in which the blood stagnates and begins to thicken. For example, a blood clot forms in the leg due to inactivity during long travel in a car, train, plane, or being bedridden after surgery.
• The signs and symptoms of blood clots depend on their location and whether they occur in an artery or vein. A blood clot in an artery that supplies blood to the heart or brain can lead to
  • heart attack,
  • hit or
  • TIA (transient ischemic attack or mini-stroke)
• When blood clots appear in a vein, symptoms may include
  • pain,
  • edema,
  • heat and
  • redness.
• If a shape of a vein in a leg or arm ruptures and travels to a lung, it causes a pulmonary embolism, a potentially life-threatening condition. Pulmonary embolism symptoms are
  • chest pain and
  • shortness of breath.
• Blood clots are initially diagnosed by history and physical examination. Other tests may be ordered depending on the location of the blood clot.
• Treatment for blood clots depends on the location, but most require anticoagulant drugs to thin the blood and prevent new clots from forming.
• Medicines used to treat blood clots thin or anticoagulate the blood.
• Complications of blood clots often depend on their location.
• Blood clots can be prevented by staying active, especially after surgery; quit smoking, especially if the woman is taking birth control pills; and lifelong management of high blood pressure, high cholesterol, and diabetes.
• The prognosis for a person with a blood clot depends on the person’s health, the location of the blood clot, and how quickly medical care is provided.

What does a blood clot look like?

Blood clotting pattern

What are the signs and symptoms of a blood clot?

Signs and symptoms of a blood clot depend on the situation, the amount of bleeding, and the location of the blood clot. Many times, the clot itself may not cause any symptoms until it embolizes and gets stuck in small blood vessels in distant parts of the body. The consequences of a lack of blood supply to the affected organ will determine the symptoms.

• In atrial fibrillation, the resulting clots may not cause symptoms unless they embolize.
• If a clot embolizes an artery in the brain, the symptoms will be those of a stroke.
• If the embolus involves an artery that supplies blood to the small or large intestine (known as mesenteric ischemia), symptoms may include abdominal pain, nausea, vomiting, and bloody bowel movements.
• In a leg or arm, a blood clot in a vein (deep vein thrombosis) can act as a dam and block the return of blood to the heart.This can cause inflammation of the vein or thrombophlebitis. Common symptoms include swelling, redness or discoloration, warmth, and pain.
• A major complication of deep vein thrombosis occurs when a clot ruptures and travels to the lung, causing a pulmonary embolism. Symptoms and signs include chest pain, shortness of breath (rapid breathing and rapid heart rate). It is a potentially life-threatening condition that depends on the extent of the lung tissue losing its blood supply and its effect on the functioning of the heart and lungs.
• Signs and symptoms of a clot depend on which organ is losing its blood supply.
  • If located in a coronary artery, there may be signs of a heart attack.
  • Occlusion of a cerebral artery by a clot manifests itself as signs of a stroke.
  • A patient with an arterial clot in an arm or leg develops a painful, cold, white, pulseless limb.

How do blood clots form?

Blood flows through the body in a continuous cycle.Blood is pumped through the body by the heart, but the same blood is pumped back to the heart both by gravity and by the muscles of the arms and legs, squeezing and squeezing, or milking, the blood back to the heart. If blood stagnates, it can thicken and cause potentially life-threatening conditions.

The medical term for a thrombus is thrombus (plural: thrombus). An embolus is a situation in which a clot breaks off from its original location and travels through the bloodstream to another location.

There are four possible outcomes for a blood clot. It will be either

1. grow,
2. dissolve,
3. embolize or
4. recannulate (a situation in which capillary blood vessels proliferate in the clot, forming new channels so that blood can resume blood flow)

Blood clots that grow in size or become embolizing can cause limb (arm, leg) disease or life-threatening.

How do you get blood clots?

It is assumed that the blood will thicken to repair the damaged blood vessel. Clots or blood clots become a problem when they don’t form properly. There are many diseases and risk factors that can lead to blood clots.

Blood clots in the heart

Atrial fibrillation describes an abnormal heart rhythm in which the upper chamber of the heart does not beat in a coordinated manner.Instead of having a single electrical impulse that allows the atrium to collapse, hundreds of electrical impulses are generated, and the atrium sways like a bowl of jelly. This can lead to the formation of small blood clots along the atrial lining. There is a possibility that these clots will rupture and embolize other parts of the body, causing diseases such as stroke or ischemic bowel (loss of blood supply to part of the intestine).

Blood clots in veins

Deep vein thrombosis (DVT) is a term used to describe clots that form in the veins of the arms, legs, or large veins in the pelvis. Risk factors for DVT include:

• Prolonged immobility
• Surgery on an arm or leg, including casting a broken bone or injury
• pregnancy
• Hereditary bleeding disorders
• smoking
• Hormone therapy, including birth control pills

Immobility may include recent surgery or hospitalization. This is especially important when it comes to leg surgery or if the limb can be immobilized in a cast or splint.This also includes patients who are undergoing hip and knee replacements. Muscle movement in the limb can be reduced, and this lack of movement increases the risk of blood clots. Long journeys in airplanes and cars keep traffic to a minimum. Blood drains off by gravity in the lowest parts of the body. If you do not stand and walk at regular intervals, blood does not easily flow back to the heart due to muscle contraction, and blood clots can form.

Blood clots in arteries

Blood clots can form sharply in an artery, which is gradually narrowed by plaque in the vessels affected by arteriosclerosis.Plaque is a collection of products of cholesterol, calcium, fibrin, and cellular waste that can form, grow, and gradually narrow an artery. If the plaque ruptures, it can initiate a clotting cascade, and the newly formed clot can completely block the artery. Risk factors for developing an arterial clot are commonly associated with heart attack, peripheral vascular disease, and stroke.

These include:

• high blood pressure,
• high cholesterol,
• smoking,
• diabetes and
• Family history of early cardiovascular disease.

Blood clots in other areas

When bleeding occurs outside an artery or vein, the blood tends to accumulate and thicken. Passing blood clots in the urine, vagina, or stool is very frightening and should not be ignored. There may be a significant problem, or the bleeding can be easily explained. For example, bleeding is commonly seen with bladder infections or hemorrhoids.

Bleeding or blood clots in the urine should not be ignored and considered “just a bladder infection”.Bleeding can be caused by a swelling of the bladder or irritation of the bladder lining for other reasons (such as radiation therapy for cancer), or it can occur in the kidneys from kidney stones or cancer. Occasionally, if there is enough bleeding in the bladder, clots will form and pass into the urine. It is commonly seen in older patients with enlarged prostates, which can cause difficulty urinating.

Blood in the stool or rectal bleeding is never normal and should always be examined.While hemorrhoids or fissures in the anus can be the source, bleeding can also be caused by a variety of other conditions, including tumors or cancer, inflammatory bowel disease, infections, and diverticular bowel disease. Again, if there is sufficient bleeding, blood clots can form and be passed on as part of a bowel movement. The passage of blood clots from the vagina almost always occurs during menstruation. If blood from the uterus pool in the vaginal area, blood clots of different sizes can form.However, vaginal bleeding during pregnancy is never normal and you should always see your doctor if it happens, by phone or in person.

When to seek medical attention for a blood clot

Usually, the signs and symptoms of a blood clot are sufficient to alert the patient and family to seek medical attention.

An arterial clot prevents oxygen and nutrient-rich blood from entering the cells, causing them to stop functioning.This usually calls for real emergency assistance and emergency services must be activated (often by calling 911).

• If oxygen-deprived cells are in the brain, then symptoms of a stroke may be evident. Time is of the essence in finding emergency care. There is a narrow window of time during which clot-breaking drugs can be used to dissolve the clot and reverse the stroke. Stroke symptoms are acronym , which means:
  • F = lowered face
  • A = arm weakness
  • S = speech difficulty
  • T = time to call 911
• A heart attack (myocardial infarction) occurs when a blood clot closes a coronary artery (one of the arteries that supplies oxygen and nutrients to the heart muscle). Signs and symptoms of heart attack include :
  • chest pain,
  • upper abdominal pain, arm, neck or jaw pain,
  • indigestion,
  • shortness of breath,
  • sweating,
  • nausea and
  • others.
• Again, timing is critical to try to restore blood supply to the heart muscle by cardiac catheterization and balloon angioplasty and stent, or by administering blood clot-breaking drugs.The goal is to open the blocked heart artery within 60 to 90 minutes after the patient arrives at the hospital.
• Other arterial clots usually cause acute onset of significant pain and signal a medical emergency.

Which doctors treat blood clots?

Many different healthcare professionals can be involved in caring for a patient with a blood clot, depending on where the clot is located and the condition of the patient.Specialists who treat blood clots include emergency department physicians; primary health care professionals, including family medicine; internal medicine; women’s health professionals; cardiologists; neurologists; pulmonologists; vascular surgeons; hematologists; interventional radiologists; and hospitalists.

How are blood clots diagnosed?

The first step in making a diagnosis of a blood clot is to obtain a history from the patient for the family. It is rare for patients to make their own diagnosis of a blood clot, so the healthcare professional will need to ask questions about what might be happening. If a blood clot or thrombus is considered, the history may expand to gain access to the patient’s risk factors or situations that could put the patient at risk of forming a clot.

• Venous blood clots (venous thrombi) often develop slowly with gradual swelling, pain, and discoloration of the affected area, and signs and symptoms will progress over several hours.
• Arterial thrombus occurs as an acute event.The tissues need oxygen immediately, and the loss of blood supply as a result of the arterial clot creates a situation in which symptoms begin immediately.

Physical examination can add information to increase the suspicion of a blood clot.

• Vital Signs are an important first step in a physical examination. Blood pressure, heart rate, respiration rate, and oxygen saturation (what percentage of red blood cells have oxygen attached to them) can give an indication of whether a patient is stable or in potential danger.
• Venous clots can cause swelling of the limb. It can be red, warm, and tender, and sometimes a physical examination can make it difficult to distinguish a venous clot from cellulite or an infection in an extremity. If there is concern about a pulmonary embolism, the examiner may listen to the heart and lungs looking for abnormal sounds caused by an area of ​​inflamed lung tissue or unusual heart sounds .
• Arterial thrombus is much more dramatic.If an arm or leg is involved, the tissue may be white due to a lack of blood supply. In addition, it may be cool to the touch, and there may be a loss of sensation and movement. The patient may writhe in pain, but cannot move the affected limb. Arterial thrombus is also the cause of heart attack, stroke and ischemic bowel.

Testing for venous blood clots

Testing will depend on the suspected location of the blood clot.

• Ultrasound: Venous blood clots can be detected in a variety of ways, although ultrasound is most commonly used today.Sometimes the size and shape of the patient can make it difficult for the ultrasound technician and radiologist to evaluate the deep veins in the arm or leg.
• Venography: Venography may be another alternative for finding a clot. A radiologist injects contrast dye into a small vein in an arm or leg and, using a fluoroscopy (video x-ray), observes how the dye fills the veins in the limb as it returns to the heart. This test is no longer used, but may be available under certain circumstances.
• Blood tests: Sometimes, a blood test is used to check for blood clots. D-dimer is a breakdown product of a blood clot and levels of this substance can be measured in the bloodstream. Blood clots are not stagnant; the body tries to dissolve them simultaneously with the addition of a new clot. The D-dimer is not specific for a blood clot in a given area and cannot tell the difference between a “good” (necessary) blood clot (formed after surgery or caused by bruising from a fall) and causing problems.It is used as a screening test in patients with a low likelihood of having a blood clot. In this case, if the result is negative, there is no need to additionally look for a diagnosis of blood clots.
• Additional tests: If a blood clot embolizes a lung, it may be a medical emergency. There are many tests available to look for a pulmonary embolism. A plain chest x-ray does not show blood clots, but can be done to look for other conditions that can cause chest pain and shortness of breath, the same signs and symptoms of embolism.An electrocardiogram (EKG) can show abnormalities that indicate a pulmonary embolism and can also show other causes of chest pain.

Computed tomography (CT) is often the test of choice when there is a high suspicion of pulmonary embolism. The contrast is given intravenously and the radiologist can determine if a clot is present.

In some cases, ventilation perfusion (V / Q) is performed to detect pulmonary embolism. This test uses labeled chemicals to identify the air you breathe into your lungs and correlate it with blood flow in your arteries.This test is less accurate than computed tomography and is subjective to deviations in interpretation.

If a pulmonary embolism is diagnosed, the amount of clot and the potential severity of the disease may require further testing. An echocardiogram is an ultrasound scan of the heart that can be used to determine how much tension is causing a blood clot in the lungs.

Testing for arterial blood clots

Arterial thrombosis is an emergency because tissues cannot exist for very long without a blood supply until irreversible damage occurs.A surgeon is often consulted in the arm or leg. Arteriography can be considered. Arteriography is a technique in which a dye is injected into the artery in question to look for a blockage. Sometimes, if a large artery is blocked, this test is performed in the operating room with the assumption that a surgical procedure will be required to open the vessel and restore blood flow.

For an acute heart attack, an ECG can confirm the diagnosis, although blood tests can also be used to look for enzymes (troponin) that enter the bloodstream from an irritated heart muscle.In acute heart attacks, cardiac catheterization is the diagnostic and therapeutic procedure of choice. A catheter is placed in the coronary artery, the blockage is identified, and a stent is placed to restore blood supply to the heart muscle.

Other options for CT of the head may be considered to look at the blood flow in the brain (CT perfusion) or the arteries themselves (CT angiogram).

For acute stroke (cerebrovascular accident, CVA), the test of choice is computed tomography (CT) of the head to find bleeding or swelling as the cause of stroke symptoms.If stroke symptoms resolve, which means a temporary ischemic attack (TIA) has occurred, tests may include ultrasound of the carotid artery to look for blockages in the main arteries of the neck and echocardiography to look for blood clots in the heart that can embolize the brain,

What is blood clot treatment?

Depending on their location, blood clots may be treated aggressively or may only need symptomatic help.

Venous thrombosis in the leg can occur in the superficial or deep vein systems.

Clots in the superficial system are often treated with symptomatic warm compresses and acetaminophen or ibuprofen, as there is no risk for clots in the superficial veins to embolize into the lung. They are connected to a deep system by the perforator veins, which have valves that act like a sieve to tighten and prevent clots from entering the lung.

Deep venous thrombosis usually requires anticoagulation to prevent clot growth and cause pulmonary embolism. Treatment usually takes place on an outpatient basis using drugs that anticoagulate or “thin” the blood. There are many medicines available to treat blood clots.

• The American College of Nursing Physicians has published guidelines for the types of blood thinners to consider when treating blood clots in the legs or lungs.
• In patients with DVT or PE and no active cancer, the new oral anticoagulant (NOAC), also known as direct oral anticoagulant (DOAC), is the drug of choice because it blocks the blood thinning coagulation cascade.
• NOACs that block coagulation factor Xa include:
• Apixaban (Eliquis)
• rivoroxiban (Xarelto)
• edoxiban (savaysa)
• dabigatran is another NOAC that is a direct thrombin inhibitor.
• Low molecular weight heparin or enoxaparin (Lovenox) is recommended for patients with DVT or PE and active cancer.
• In unstable patients or those who fear that they will become unstable in the near future and need hospitalization, the recommended anticoagulant drug is intravenous unfractionated heparin. When there is a large amount of blood clot in the pulmonary arteries, the stress on the heart and lungs can be stressful, and thrombolytic therapy with tissue plasminogen activator (tPA) drugs, so-called clot-killing drugs, can be considered.These patients are usually critically ill and in shock.
• If there is a large amount of clot in the femoral or iliac veins, the blood cannot leave the leg and it becomes severely swollen, swollen and blue. This is called cerulial dolens phlegm and may require treatment with tPA. Similar situations can occur in the arm with clots that form in the subclavian or axillary vein.
• Classically, warfarin (Coumadin) has been most commonly used to treat blood clots.It is an inhibitor of vitamin K and affects factors II, VII, IX and X of the blood coagulation cascade. Since it takes several days to reach therapeutic levels, the patient was also prescribed an injectable heparin product (enoxaparin, fondaparinux) as a bridge to immediately dilute the blood.

Blood clots below the knee are at less risk of pulmonary embolization, and an alternative to anticoagulant treatment is serial ultrasound to monitor the clot to see if it is stable or growing.

Pulmonary embolism is treated similarly to deep vein thrombosis. Patients with increased dyspnea or weakness may require hospitalization during the initial phase of treatment. In certain situations where there is a large amount of blood clot in the pulmonary arteries, the stress on the heart and lungs can be stressful, and thrombolytic therapy with tissue plasminogen activating (tPA) drugs, so-called clot-breaking drugs, may be considered.These patients are usually critically ill and in shock.

Arterial blood clots are often more aggressively managed. Surgery may be attempted to remove the clot, or drugs may be injected directly into the clot to try to dissolve it. Alteplase (Activase, tPA) or tenecteplase (TNKase) are examples of clot-rupture drugs that can be used in peripheral arteries to try to restore blood supply.

Heart Attack: The same approach is used for heart attack as for arterial blood clots. If possible, cardiac catheterization is performed to locate the blocked blood vessel and a balloon is used to open it, restore blood flow, and place a stent to keep it open. It is a time-sensitive procedure, and if the local hospital is unable to perform an emergency cardiac catheterization within 60-90 minutes of the patient’s arrival at the hospital, the thrombolytic drugs described above, such as tPA or TNK, can be used intravenously to try to dissolve the blood clot and minimize damage to the heart muscle.It will still be necessary to eventually transfer the patient, when stable, to a hospital capable of cardiac catheterization.

Stroke is also treated with tPA if the patient is a suitable candidate for this treatment. Every patient is different and may or may not qualify for this acute stroke drug. Again, this is a time sensitive emergency, and in addition to tPA, an interventional radiologist can place a catheter in the blood vessels of the brain, identify the clot and remove it, so hopefully it will reverse course.

What medications treat blood clots?

Treatment of blood clots is often directed at interfering with the body’s normal clotting mechanism. Various drugs can be used to block certain factors in the blood coagulation cascade and are selected based on the disease or disease being treated and other underlying medical problems that are present in the individual patient. Some of the medications prevent additional or future blood clots, while others can help dissolve existing blood clots.

Aspirin is commonly used to reduce platelet function (platelets are important for blood clot formation) in the treatment of heart attacks and strokes. Other antiplatelet drugs include clopidogrel (Plavix), prasugrel (effective), ticagrelor (brillanta), ticlopidine (ticlide), and aspirin and dipyridamole (aggrenox).

Warfarin (Coumadin) acts as a blood thinner by blocking clotting factors (II, VII, IX, and X) that are dependent on vitamin K. Each patient is unique when it comes to warfarin (Coumadin) dosage and repeated blood tests are usually done to make sure the blood is anticoagulating to the appropriate level.There are many drug interactions with this drug that can cause the blood to become “too thin”, such as some antibiotics. The dosing of warfarin (Coumadin) should always be monitored by a healthcare professional and the patient should never change the dose of this medication without consulting a healthcare professional.

Factor Xa inhibitor drugs have been approved for the treatment of certain types of atrial fibrillation, deep vein thrombosis and pulmonary embolism.They start working almost immediately and do not need blood tests to monitor their activity. Medicines in this class of anticoagulants include apixaban (Eliquis), rivaroxaban (Xarelto), and edoxaban (Savaysa). Dabigatran (Pradaxa) is also an alternative anticoagulant drug that is a direct thrombin inhibitor. Unlike warfarin, which can reverse its anticoagulant activity, there is currently no reversal facility for factor Xa and thrombin inhibitor drugs in the United States.These drugs can also be used to prevent blood clots in the leg after hip and knee replacement surgery.

Heparin works by inactivating thrombin and factor X. It is an injectable drug available for intravenous or low molecular weight treatment called enoxaparin (Lovenox) or fondaparinux (Arixtra), which can be injected subcutaneously (under the skin). Heparin is often used as part of a heart attack treatment protocol. Because of its rapid onset of action, it is often the first treatment started as soon as a blood clot is diagnosed in a hospital.

Tissue Plasminogen Activator (tPA or TNK) can be used to dissolve blood clots, which are life-threatening and are most commonly used for blood clots that clog arteries in situations such as stroke or heart attack; there are times when the drug is used to obstruct large veins. The medicine can be injected into an intravenous line that was started in a vein in the arm, or it can be dripped directly into the clot. This requires special intensive care technology and the skills of a doctor to guide the catheter to the site of the blockage in order to deliver the drug that breaks the clot.Decisions regarding the use of this drug are individual for the individual patient and situation.

Are there natural cures or home remedies for blood clots?

Acknowledging that a potential disease may be due to a blood clot is the first step to getting treatment. Since many of these conditions are life-threatening (heart attack, stroke, pulmonary embolism, ischemic bowel), accessing emergency services and calling 911 can be the most important step in treatment.

What about blood clot surgery?

Depending on the underlying disease, an operation to remove a blood clot may be required. This often occurs in life-threatening or limb-threatening situations in which anticoagulation with heparin or the use of thrombolytic drugs is inappropriate, or when they cannot clear a blood clot.

Do I need to see a doctor after treatment for a blood clot?

Depending on the underlying medical condition, blood clot health care may be ongoing and a return visit to a healthcare professional may be required.Patients who have DVT or PE should be risk stratified (determine the risk of another blood clot and compare it with the risk of being a blood thinner) in an attempt to figure out why the clot is formed. This will help in deciding whether they will only be anticoagulated for a short period of time, or if it should be lifelong to prevent future clot formation.

How can blood clots be prevented?

Prevention is always key in medicine.This is especially true when it comes to many diseases associated with blood clots.

• The risk of arterial blood clots associated with heart disease, stroke and peripheral arterial disease can be minimized by keeping high blood pressure, diabetes and cholesterol levels under control. Smoking cessation should be a priority.
• Prevention of deep vein thrombosis and pulmonary embolism is a priority in hospitalized patients.Often times, those undergoing surgery are strongly advised to start walking as early as possible, and medications can be used prophylactically to prevent clot formation.
• Travelers should be encouraged to get up, stretch and walk regularly. This is especially true on long plane trips or long car trips.
• Hormone therapy is a risk of blood clot formation, and smoking is a risk. People who choose to smoke should notify their healthcare professional; The benefits of birth control and / or hormone replacement therapy must be balanced against the risk of complications.

What are the prospects for a person with a blood clot?

There are many patients who are not aware that they had a blood clot in their leg, either because the symptoms were mild or the symptoms were ignored. Up to 25% of patients with pulmonary embolism die from sudden death.

For those patients with provoked deep vein thrombosis, the cause of which is known and is temporary, there is a small risk of a blood clot in the future after completion of the initial anticoagulation treatment.

Patients with unprovoked DVT or PE or active cancer or a bleeding disorder that increases the likelihood of blood clotting may require lifelong anticoagulation. The guidelines suggest that this decision will be reviewed every year.

For all patients, the patient and healthcare professional must balance the benefits of anticoagulation with the risk of bleeding complications. The doctor will try to match the blood thinner to the patient’s situation to minimize the risk of bleeding.

90,000 Fibromuscular dysplasia: symptoms, treatment and life expectancy

What is fibromuscular dysplasia?

Fibromuscular dysplasia (foot and mouth disease) is a condition that causes additional cells to grow within the walls of arteries. Arteries are blood vessels that carry blood from your heart to the rest of your body. The extra cell growth narrows the arteries, allowing less blood to flow through them. It can also lead to bulges (aneurysms) and tears (dissections) in the arteries.

FMD usually affects the medium-sized arteries that supply blood:

• kidney (renal arteries)
• brain (carotid arteries)
• abdomen or intestines (mesenteric arteries)
• hands and feet

Reduced blood flow to these organs can cause permanent damage.

Foot and mouth disease affects 1 to 5 percent of Americans. About a third of people with this condition have it in more than one artery.

What are the signs and symptoms?

FMD does not always cause symptoms.When this happens, the symptoms depend on which organs are affected.

Symptoms of decreased blood flow to the kidneys include:

• side pain
• high blood pressure
• kidney shrinkage
• impaired renal function on a blood test

Symptoms of decreased blood flow to the brain include:

• Headache
• dizziness
• neck pain
• ringing in the ears
• saggy eyelids

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• Stroke Or Mini Hit

Symptoms of decreased abdominal blood flow include:

• abdominal pain after eating
• unexplained weight loss

Symptoms of decreased blood flow to the arms and legs include:

• Pain in the affected limb when walking or running
• weakness or numbness
• Temperature or color changes in the affected limb

What is causing this?

Doctors are unsure what causes foot and mouth disease.However, the researchers settled on three main theories:

genes

About 10 percent of FMD cases occur in members of the same family, suggesting that genetics may play a role. However, just because your parent or sister has a condition does not mean that you will get it. In addition, family members may have foot and mouth disease, which affects various arteries.

Hormones

Women are three to four times more likely to develop foot-and-mouth disease than men, suggesting that female hormones may be involved.However, more research is needed to confirm this.

Abnormal arteries

Lack of oxygen in the arteries during their formation can lead to their abnormal development, which will lead to a decrease in blood flow.

Who gets it?

Although the exact cause of FMD is unknown, there are several factors that can increase your chances of developing it. This includes:

• Be a woman under the age of 50
• the presence of one or more family members with the condition
• smoking

How is it diagnosed?

Your doctor may suspect you have foot and mouth disease when you hear a noise while listening to your artery with a stethoscope.In addition to assessing your other symptoms, they may also use an imaging test to confirm your diagnosis.

Imaging tests used to diagnose foot and mouth disease include:

• Duplex (Doppler) Ultrasound . This test uses high frequency sound waves and a computer to create images of your blood vessels. This can show how well blood is flowing through your arteries.
• Magnetic Resonance Angiography .This test uses powerful magnets and radio waves to create images of your blood vessels.
• Computed tomography, angiography . This test uses X-rays and a contrast dye to produce detailed images of your blood vessels.
• Arteriography . If non-invasive tests cannot confirm the diagnosis, you may need an arteriogram. This test uses a contrast dye injected through a wire into the groin or the affected area of ​​the body.X-rays are then taken from your blood vessels.

How is it treated?

There is no cure for foot and mouth disease, but you can deal with it. Treatment can help you manage your symptoms and prevent complications of the disease.

Many people find some relief from blood pressure medications, including:

• angiotensin II receptor blockers: candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar), valsartan (Diovan)
• angiotensin-converting enzyme inhibitors (ACE inhibitors) : benazepril (lotensin), enalapril (vazotec), lisinopril (prinvil, zestril)
• beta – blockers: atenolol (tenormin), metoprolol (lopressor, toprol-XL)
• calcium channel blockers: amlodipine (Norvasc), nifedipine (Adalat CC, Afeditab CR, Procardia)

You may also need to take blood thinners such as aspirin to prevent blood clots.This makes it easier for blood to pass through narrowed arteries.

Additional treatment options include:

Percutaneous transluminal angioplasty

A thin tube called a balloon catheter is threaded into a narrowed artery. The balloon is then inflated to keep the artery open.

Operation

If you have a blocked or narrow artery, you may need surgery to remove it. Your surgeon will either remove the blocked part of your artery or redirect blood flow around it.

How does this affect life expectancy?

Foot and mouth disease is usually a lifelong condition. However, researchers have not found any evidence that it lowers life expectancy, and many people with FMD live into the 80s and 90s.

Work with your doctor to find the best way to manage your symptoms, and be sure to let them know if you notice any new symptoms, including:

• vision changes
• speech changes
• unexplained changes in your hands or feet

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