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Azilsartan medoxomil - (edarbi ®)

Initial U.S. Approval: 2011
Edarbi (azilsartan medoxomil), a prodrug, is hydrolyzed to azilsartan in the gastrointestinal tract during absorption. Azilsartan is a selective AT1 subtype angiotensin II receptor antagonist.

Edarbi is an angiotensin II receptor blocker indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. Edarbi may be used, either alone or in combination with other antihypertensive agents.

The recommended dose in adults is 80 mg taken once daily. Consider a starting dose of 40 mg for patients who are treated with high doses of diuretics.

Edarbi may be administered with or without food.
Edarbi may be administered with other antihypertensive agents.

Tablets: 40 mg and 80 mg.

Candesartan (atacand ®)

 Supplied:  4 mg, 8 mg, 16 mg, 32 mg

: Oral: Initial: 16 mg once daily.   Range: 4 to 32 mg once daily. Dosage must be individualized.  It can be administered once or twice daily with total daily doses ranging from 8-32 mg.  
: Oral: Initial: 4 mg once daily.   Double the dose at 2-week intervals, as tolerated; target dose: 32 mg.

Eprosartan mesylate (teveten) ®

 Supplied:  400 mg, 600 mg

: Oral: Usual initial dose is 600 mg once daily. Dosage must be individualized. Can administer once or twice daily with total daily doses of 400 to 800 mg.  Limited clinical experience with doses greater than 800 mg.

Irbesartan (avapro ®) 

Supplied:  75 mg, 150 mg, 300 mg
Hypertension: Oral: 150 mg once daily ... patients may be titrated to 300 mg once daily. Note: Starting dose in volume-depleted patients should be 75 mg.

Losartan (cozaar ®) 

Dosing: Oral: 

Children 6-16 years: 0.7 mg/kg once daily (maximum: 50 mg/day); adjust dose based on response; doses >1.4 mg/kg (maximum: 100 mg) have not been studied

Adults: Usual starting dose: 50 mg once daily; can be administered once or twice daily with total daily doses ranging from 25-100 mg

Patients receiving diuretics or with intravascular volume depletion:
Usual initial dose: 25 mg

Nephropathy in patients with type 2 diabetes and hypertension: Adults: Initial: 50 mg once daily; can be increased to 100 mg once daily based on blood pressure response

Stroke reduction (HTN with LVH): Adults: 50 mg once daily (maximum daily dose: 100 mg); may be used in combination with a thiazide diuretic

Dosing adjustment in renal impairment :
Children: Use is not recommended if cr<30 mL/minute.
Adults: No adjustment necessary.

Dosing adjustment in hepatic impairment : Reduce the initial dose to 25 mg/day; divide dosage intervals into two.

Supplied25 mg, 50 mg, 100 mg

Olmesartan (benicar ®) 

Supplied:  5 mg, 20 mg, 40 mg
Hypertension: Oral: Initial: Usual starting dose is 20 mg once daily.  If initial response is inadequate, may be increased to 40 mg once daily after 2 weeks. Consider lower starting dose in patients with possible volume deficits.

Telmisartan (micardis ®)

Supplied:  20 mg, 40 mg, 80 mg
Hypertension: Oral: Initial: 40 mg once daily.  Usual maintenance dose range: 20 to 80 mg per day. Patients with volume depletion should be initiated on the lower dosage with close supervision. 

Valsartan (diovan ®) 

Supplied:  40 mg, 80 mg, 160 mg, 320 mg

: Initial: 80 mg or 160 mg once daily (in patients who are not volume depleted). Dose may be increased to achieve desired effect ... maximum recommended dose: 320 mg per day.

CHF: Initial: 40 mg twice daily. Titrate dose to 80 to 160 mg twice daily, as tolerated.  Maximum daily dose: 320 mg.   
Left ventricular dysfunction after MI
: Initial: 20 mg twice daily. Titrate dose to target of 160 mg twice daily as tolerated.

Decreased renal perfusion 

RAA cascade

Entresto™- sacubitril and valsartan tablet 

Drug UPDATES:  ENTRESTO™- sacubitril and valsartan tablet
[Drug information  /  PDFled  -Click link for the latest monograph
Dosing:  Click (+) next to Dosage and Administration section (drug info link)

Initial U.S. Approval:  2015

Mechanism of Action:
ENTRESTO contains a neprilysin inhibitor, sacubitril, and an angiotensin receptor blocker, valsartan. ENTRESTO inhibits neprilysin (neutral endopeptidase; NEP) via LBQ657, the active metabolite of the prodrug sacubitril, and blocks the angiotensin II type-1 (AT1) receptor via valsartan. The cardiovascular and renal effects of ENTRESTO in heart failure patients are attributed to the increased levels of peptides that are degraded by neprilysin, such as natriuretic peptides, by LBQ657, and the simultaneous inhibition of the effects of angiotensin II by valsartan. Valsartan inhibits the effects of angiotensin II by selectively blocking the AT1 receptor, and also inhibits angiotensin II-dependent aldosterone release.

1.1 Heart Failure
ENTRESTO is indicated to reduce the risk of cardiovascular death and hospitalization for heart failure in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.
ENTRESTO is usually administered in conjunction with other heart failure therapies, in place of an ACE inhibitor or other ARB.

ENTRESTO is supplied as unscored, ovaloid, film-coated tablets in the following strengths:
ENTRESTO 24/26 mg, (sacubitril 24 mg and valsartan 26 mg) are violet white and debossed with "NVR" on one side and "LZ" on the other side.
ENTRESTO 49/51 mg, (sacubitril 49 mg and valsartan 51 mg) are pale yellow and debossed with "NVR" on one side and "L1" on the other side.
ENTRESTO 97/103 mg, (sacubitril 97 mg and valsartan 103 mg) are light pink and debossed with "NVR" on one side and "L11" on the other side.


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Angiotensin II inhibitors