2008;43:14–20. http://www.pbm.va.gov/criteria/AIIRA.pdf. 1. The hypothesis of this study was that valsartan 80 mg or losartan 50 mg once daily provided BP control similar to that provided by irbesartan 150 mg once daily and that valsartan 160 mg and losartan 100 mg once daily provided BP control similar to that provided by irbesartan 300 mg once daily. Once the study population was identified, the 4 most recent BP values recorded before the switch were compared with the first 4 BP values recorded after the switch. Reference 539 540 1. Note: Starting dose in volume-depleted patients should be 75 mg. Losartan (Cozaar ®) Supplied: 25 mg, 50 mg, 100 mg Dosing: Hypertension: Oral: Initial: 25 to 50 mg once daily. Posted 13 January 2008 at 10:26. Use 2001;358:1556 and Lancet. Irbesartan (Avapro ®) Supplied: 75 mg, 150 mg, 300 mg Dosing: Hypertension: Oral: 150 mg once daily ... patients may be titrated to 300 mg once daily. General information. It is a nonpolar compound with a partition coefficient (octanol/water) of 10.1 at pH of 7.4. Lancet. Angiotensin II Receptor Blocker (ARB) - Comparable Dose Chart - Valsartan (Diovan®) 40 mg daily - Candesartan (Atacand®) 4 mg daily - Irbesartan (Avapro®) 75 mg daily - Losartan (Cozaar®) 25 mg daily - Olmesartan (Benicar®) 10 mg daily - Telmisartan (Micardis®) 20 mg daily #ARB #Equivalent #Conversion #Dosing #Doseage #Table #AngiotensinII #Receptor #Blocker 6. http://www1.va.gov/vetdata/docs/4X6_fall07_sharepoint.pdf. It is classified as either primary (essential) or secondary. Losartan has attracted interest from the medical community because losartan was used in some preclinical studies to determine its effectiveness against the SARS virus that first appeared in 2002. to study hypotensive and ñerebroprotective efficacy of ARB irbesartan and losartan in hypertensive patients. All attributes Differences Similarities. 2000;342:1376 and N Engl J Med. Currently, the VANF lists ARBs as second-line agents after ACE inhibitors for the treatment of VA beneficiaries with hypertension, HF, and proteinuria.20 ARBs are reserved for those patients who have an adverse reaction to ACE inhibitor therapy. Additionally, the 3 most recent serum creatinine and serum potassium values before the switch were compared with the first 3 values after the switch. lovastatin pravastatin simvastatin % ldl reduction (mevacor*) (pravachol*) (zocor*) lescol lipitor crestor vytorin 25-32% 20 mg 20mg 10mg 40mg - - - 31-39% 40mg 40mg 20mg 80mg 10mg - - 37-45% 80mg 80mg 40mg - 20mg 5mg 10/10 Switching from lisinopril to losartan may help reduce the likelihood of developing a dry cough. Parving HH, Lehnert H, Brochner-Mortensen J, Gomis R, Andersen S, Arner P; Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria Study Group. In 2005, irbesartan was removed from the formulary and was replaced with valsartan and losartan. Depending on what valsartan or irbesartan dose, select an equivalent dose of … Dr Williams was a primary care pharmacy practice resident at the William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia, South Carolina, from 2006 to 2007. Since ACE inhibitors may increase blood levels of potassium, the use of potassium supplements, salt substitutes (which often contain potassium), or other drugs that increase the body's potassium may result in excessive blood potassium levels. Losartan and valsartan are categorized as angiotensin II receptor blockers (ARBs).These drugs mainly treat hypertension -- also commonly known as high blood pressure. Secondarily, serum creatinine and serum potassium levels were evaluated to determine if the dosing switch resulted in similar adverse-effect profiles. Definition. “Comparison of Oral ACE inhibitors.” Pharmacist’s Letter/ Prescriber’s Letter, Avapro is also used to treat kidney problems caused by type 2 (non-insulin-dependent) diabetes. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Irbesartan (Avapro) 75 mg 150 mg 300 mg 300 mg Losartan* (Cozaar) 25 mg 50 mg 100 mg -- Olmesartan (Benicar) 10 mg 20 mg 20 to 40 mg 40 mg Telmisartan (Micardis) 20 mg 40 mg 40 to 80 mg 80 mg Note: Dose equivalencies are approximate. If no comorbidity was present, the choice of agent was left to the prescriber's discretion. Angiotensin converting enzyme (ACE) inhibitor antihypertensive dose comparison. Until 2005, irbesartan was the only ARB available on the Veterans Affairs (VA) healthcare system's national formulary. These guidelines suggested that patients taking irbesartan 150 mg once daily be treated with either valsartan 80 mg or losartan 50 mg once daily and that patients taking irbesartan 300 mg once daily be treated with either valsartan 160 mg or losartan 100 mg once daily. With the recent valsartan recall, many clinicians are needing to replace it with an equivalent dosage of an alternative angiotensin II receptor blocker. For those patients who were to continue with ARB therapy via a switch to either losartan or valsartan, dosing guidelines were created by the Veterans Integrated System Network 7 (VISN 7) to facilitate the change. Losartan 50 mg once daily for four weeks, followed by losartan 100 mg once daily for four weeks. Avapro is also used to treat kidney problems caused by type 2 (non-insulin-dependent) diabetes. The generic versions of losartan and valsartan made national headlines this past year when the FDA announced a significant number of recalls after finding carcinogens in both drugs. Drug: losartan potassium losartan potassium oral tablet at either 50mg or 100 mg daily dose. For people who have diabetes and hypertension, candesartan, irbesartan, losartan, or valsartan may be preferred. Answer. Telmisartan, explained Bakris, is the longest-acting ARB, and there are clear differences in binding to the AT 1 receptor, with approximately 25% greater binding of telmisartan compared with losartan. Circulation. 2000;342:748]. 8. Cohn JN, Tognoni G; Valsartan Heart Failure Trial Investigators. Furthermore, irbesartan can be a good substitute for losartan in view of the fact that at least the uric acid level is not increased. Acknowledgment: The authors wish to thank Jack P. Ginsberg, PhD, at the Williams Jennings Bryan Dorn Veterans Affairs Medical Center, for his assistance with this article. © 2021 MJH Life Sciences™ and Formulary Watch. After a placebo lead-in, 567 patients were randomized (1:1:1:1) to once-daily therapy with placebo, 100 mg losartan, 150 mg irbesartan, or 300 mg irbesartan for 8 weeks. 2. Lancet. Selection of which Formulary ... irbesartan (Avapro) 75 mg once daily valsartan 40 mg once daily losartan … Losartan. CrCl < 10 mL/minute: use in adults has not been studied; use with caution. 1999;33:936-938. Calculation of equivalent doses of antihypertensive drugs : β-Blocker The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. 5. 1 formulary drug 2 automaticaly interchanged to candesartan at an equivalent dose given once daily. Patients with only 1 observation either before or after the switch were excluded. Summary: We compare the side effects and drug effectiveness of Irbesartan and Losartan. In several studies irbesartan has shown greater efficacy in treating hypertension than losartan and has proved to be at least as effective as other ARB agents. Angioedema due to losartan. 20. The mean score of available observations was substituted for missing observations in the period before the switch for patients who had only 2 or 3 available BP measurements before the switch and for patients with only 2 serum creatinine or serum potassium measurements before the switch. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: Randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). United States Department of Veterans Affairs website. To determine if the dosing guidelines resulted in equal antihypertensive effectiveness, we carried out a retrospective chart review, examining the cases of 86 patients at the William Jennings Bryan Dorn VA Medical Center in Columbia, South Carolina, who had switched from irbesartan to either losartan or valsartan. Valsartan, candesartan, irbesartan, all are good too.There is a theory that losartan, despite its current popularity, is NOT the best drug to use because it is a surmountable drug, meaning it could theoretically lose effectiveness over time. are Ann Pharmacother. Sarkar P, Nicholson G, Hall G. Brief review: angiotensin converting enzyme inhibitors and angioedema: anesthetic implications. Irbesartan USP is an angiotensin II receptor (AT1 subtype) antagonist.Irbesartan USP is a non-peptide compound, chemically described as a 2-butyl-3-[p-(o-1H-tetrazol-5-ylphenyl)benzyl]-1,3-diazaspiro[4.4]non-1-en-4-one.Its empirical formula is C 25H 28N 6O, and the structural formula:Irbesartan USP is a white to off-white crystalline powder with a molecular weight of 428.5. telmisartan 40 mg, valsartan 80 mg, Conversion Therefore, at the William Jennings Bryan Dorn VA Medical Center (Dorn) located in Columbia, South Carolina, we undertook a study to retrospectively review the cases of patients who were switched from irbesartan to losartan or valsartan because of the formulary changes described earlier. 10. Angiotensin Receptor Blockers Recommended Dose Conversions Valsartan Irbesartan Losartan Olmesartan Telmisartan Candesartan Azilsartan Eprosartan A few months ago the FDA recalled valsartan, then yesterday there was a notice of irbesartan recalls. PROGRESS Collaborative Group. It is classified as either primary (essential) or secondary. Lancet. Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies [erratum in Lancet. We did not have the ability to standardize the dosing of any additional antihypertensive agents, which may or may not have caused additional changes in BP measurements or in serum creatinine or serum potassium levels. Dr Sease is a clinical assistant professor in the Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia. VHA Pharmacy Benefits Management–Strategic Healthcare Group and Medical Advisory Panel. telmisartan 40 mg, Use ; Losartan is available as a very affordable generic. Equivalent to Lisinopril 10mg. Cozaar (Losartan) is a good blood pressure-lowering medicine that protects kidney function like an ACE inhibitor, but with fewer side effects. To be included, patients must have been switched from irbesartan 150 mg once daily to valsartan 80 mg or losartan 50 mg once daily or from irbesartan 300 mg once daily to valsartan 160 mg or losartan 100 mg once daily according to the VISN 7 guidelines. Definition. irbesartan/HCTZ: Diabetic nephropathy 150 mg once dailyb 300 mg once daily 300 mg 150/12.5 mg, 300/12.5 mg Losartan Hypertension 25 mg once dailya,b 50–100 mg once dailyb 100 mg 25 mg, 50 mg, 100 mg losartan/HCTZ: Diabetic nephropathy 50 mg once dailyb 50–100 mg once daily depending on BP 100 mg 50/12.5 mg, 100/25 mg Approximate to Lisinopril 80mg TO Candesartan (per Regional Therapeutic Interchange) She had dizziness when she briefly tried Losartan before. Updated October 25, 2007. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. Losartan Drug Class: Angiotensin-receptor blockers Phase (solid/liquid): Solid Legal Status: Rx -only Molecular mass: 422.91 Possible Side Effects: Dizziness, Lightheadedness, Fainting, Irregular Heartbeat, Skin Rashes, Swelling, Difficulty Breathing Melting Point: 184 Losartan is the first drug to be marketed within the ARB class and has been shown to be relatively ineffective for 24‐hour control of blood pressure. However, these two drugs have some key differences, including what other conditions they can treat and how they’re taken. 14. van Rijnsoever EW, Kwee-Zuiderwijk WJ, Feenstra J. Angioneurotic edema attributed to the use of losartan. Hypertension : Losartan Potassium Vs. Irbesartan. Angiotensin II receptor antagonist criteria for use in veteran patients. Following randomization, 37 patients (12 placebo, 7 100 mg losartan, 12 150 mg irbesartan, and 6 300 mg irbesartan) withdrew. Outcome Measures. The phase IV clinical study is created by eHealthMe based on reports (from sources including the FDA) of 189,195 people who take Losartan potassium and Irbesartan, and is updated regularly. equivalent to candesartan 8 mg, Conversion FROM Candesartan Losartan is made as a stand-alone drug, and in a combination tablet with the diuretic, hydrochlorothiazide (HCTZ), as losartan/HCTZ.Convenient. It was also expected that the medication switch would not cause a significant difference in BP control, serum potassium levels, or serum creatinine levels. It is the opposite of hypotension. (Formulary. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Background: Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) reduce cardiovascular disease (CVD) events, but a recent meta-analysis of selected studies suggested that ARBs may increase cancer risks. 4. 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