The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. Patients with only 1 observation either before or after the switch were excluded. N Engl J Med. Kidney Disease Outcomes Quality Initiative (K/DOQI). No statistically significant difference was observed between the BP measurements taken before and after the switch (F [3,209]=.11; P=.95). PLEASE cover your mouth!! Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. More blood pressure medication recalled: Company recalls 80 lots of valsartan over cancer concerns. 2000;342:748]. MD. If on 80 mg BID, daily dose is 160 mg. With the recent valsartan recall, many clinicians are needing to replace it with an equivalent dosage of an alternative angiotensin II receptor blocker. Answered by : Dr. Benard Shehu ( Cardiologist) Can Losartan be replaced by Valsartan? Patients must have been receiving each drug (irbesartan before the switch and valsartan or losartan after the switch) for ≥2 weeks for the treatment of hypertension and/or for another compelling indication for ARB therapy such as diabetes, CKD, or HF. 2003;349: 1893–1906. The presence of comorbid conditions was determined based on whether particular conditions were documented within patients' medical records. 2001;345:861–869. Please hit thanks. You are already signed-up with us. Diabetes Care. 2001;358:1033–1041. Based on an extrapolation of these guidelines, patients were also included if they were taking irbesartan 75 mg once daily and were switched to either valsartan 40 mg or losartan 25 mg once daily. ), ACE inhibitors have been studied in a variety of patient populations, including in patients with HF, CKD, diabetes, chronic stable angina, MI, and stroke.5–10 ACE inhibitors produce their pharmacologic effects by blocking the conversion of angiotensin I to angiotensin II, which is a potent vasoconstrictor and stimulator of aldosterone secretion.11 Additionally, ACE inhibitors block the degradation of bradykinin, which is a vasodilator; bradykinin is also one of the molecules responsible for the side effect of dry cough, which occurs in ≤20% of patients treated with an ACE inhibitor.11, Like ACE inhibitors, ARBs also inhibit angiotensin II, but they exert their effect through direct inhibition of angiotensin II type 1 receptors.11 As a result, ARBs induce vasodilation and aldosterone inhibition but do not affect the breakdown of bradykinin and, therefore, are unlikely to be associated with cough.11 Like ACE inhibitors, ARBs have also been studied in several patient groups with hypertension and specific compelling indications including HF, MI, and diabetic nephropathy.12–17, Potential adverse effects that may occur with both ACE inhibitors and ARBs include hyperkalemia, kidney insufficiency, angioedema, and orthostatic hypotension.11 When patients begin treatment with either an ACE inhibitor or an ARB, their BP, serum potassium, blood urea nitrogen, and serum creatinine levels should be monitored.11 Angioedema generally occurs less often with ARBs than with ACE inhibitors, but cross-reactivity is possible.11 Therefore, ARBs should be used with caution in patients with a history of angioedema.11 Overall, ARBs seem to be the most well-tolerated agents among the antihypertensive drugs that are available.18, In addition to JNC 7, other national guidelines also describe appropriate therapeutic uses for ACE inhibitors and ARBs.5–7 The American Heart Association/American College of Cardiology (AHA/ACC) guidelines recommend ACE inhibitors or ARBs (in those patients intolerant to ACE inhibitors) for all post-MI patients with signs of HF and for those with a low ejection fraction.5 ACE inhibitors are recommended by the AHA/ACC for all patients with left ventricular systolic dysfunction HF, and ARBs are considered to be a "reasonable alternative" in patients who are intolerant to ACE inhibitors.5 The National Kidney Foundation (NKF) recommends that patients with diabetic or nondiabetic CKD and with or without hypertension be treated with an ACE inhibitor or an ARB.6 The NKF makes no claims of superiority between the classes, as no current trial compares the 2 classes of drugs head-to-head in patients with kidney disease.6 The American Diabetes Association (ADA) makes a similar recommendation in stating that ACE inhibitors and ARBs should be used in diabetic patients to treat any degree of albuminuria, a possible precursor to CKD.7, ARBs and the Veterans Affairs healthcare system. 2002;106: 672–678. I was prescribed Valsartan 40mg daily among other meds 4 years ago after a triple bypass in the US. If you take Losartan 50 mg in the morning, you may notice your blood pressure rises at night, because it’s not covering you for … 1 doctor agrees 0 11 similar Hypertension Drugs to Valsartan. valsartan: Diovan/hcl is valsartan/hcl and losartan/hcl is a different drug combination but closely related as both are angiotensin receptor blockers. BP Reduction - Monotherapy Irbesartan Most studies: 8-16 mg/d 150 mg/d – equivalent to Losartan 100 mg/d 300 mg/d – better than Losartan 100 mg/d – equivalent to Valsartan 160 mg/d Mean SBP reduction: 10-12 mmHg Mean DBP reduction: 10 mmHg 29. Fox KM; European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease Investigators. Can Losartan 100 mg replace Valsartan 325mg that is being taken with Hydrochlorothiazide 25 mg Amlodipine Besylate 10mg for high blood pressure? Circulation. Although therapeutic interchanges among ARBs may occur in healthcare systems throughout the United States because of formulary restrictions or drug availability, little information has been published describing the protocols that guide these switches or the effects of such switches on BP measurements, serum creatinine levels, or serum potassium levels. Dosages of 100mg per day or more of losartan will last for 24 hours. 9. http://www1.va.gov/vetdata/docs/4X6_fall07_sharepoint.pdf. Updated July 27, 2007. Despite these concerns, we believe that using a doubly multivariate, repeated-measure, mixed-model ANOVA for BP and a repeated-measure, mixed-model ANOVA for serum creatinine and serum potassium levels provided sufficient power to determine whether even a small difference between treatment groups existed. VA benefits and health care utilization. Equivalent ARB daily dosing for valsartan in adults ... 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. In 2005, irbesartan was removed from the formulary and was replaced with valsartan and losartan. In 2005, irbesartan was removed from the VANF and replaced with valsartan and losartan because of contract changes that made valsartan and losartan the most cost-efficient ARBs available for use by the VA healthcare system. Although the generalizability of these results may be limited, as the study was restricted to a small, mostly male population of veterans, we believe that the results demonstrate the therapeutic equivalence of specific doses of irbesartan, losartan, and valsartan. ... View answer. Demographic data such as age, race, sex, and comorbidities were also recorded. Losartan, taken once daily, does not last the full 24 hours at lower doses like 25 or 50 mg. At 100 mg daily losartan does last the full 24 hours. In the case of proteinuria, ARBs may be added to ACE inhibitor therapy if proteinuria persists despite maximal ACE inhibitor therapy.20. I accidentally took a second dose. If no comorbidity was present, the choice of agent was left to the prescriber's discretion. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. In that case, it would better to avoid antidepressant. 2001;23:1999–2010. My new VA doctor wants to change one of my blood pressure medications from 160 mg of Valsartan 2 times per day to an equivalent dose of 100 mg of Losartan but only once per day. 18. Clin Ther. Compare Irbesartan vs. Dr. Diovan My new VA doctor wants to change one of my blood pressure medications from 160 mg of Valsartan 2 times per day to an equivalent dose of 100 mg of Losartan but only once per day. Hypertension. 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. I have been taking losartan hydoclorizada for several years 100mg/25mg. When BP, serum creatinine, or serum potassium measurements were missing after the switch, the last observation was carried forward to complete the data set. Lisinopril can be used to treat high blood pressure, heart failure, and … High-dose ARB: total daily dose of >160 mg valsartan or therapeutically equivalent dose of another ARB (eg, losartan >50 mg; olmesartan >10 mg) 2. The total daily dose of losartan may be divided and administered two doses daily. 2008;43:14–20. As of fiscal year 2006, 7.9 million veterans were enrolled in the United States Department of Veterans Affairs (VA) healthcare system, which provides comprehensive healthcare and prescription drug coverage.19 In order for all eligible beneficiaries to receive the medication therapies that they need, the VA healthcare system has a medication formulary system in place (the VA national formulary [VANF]) that ensures appropriate and efficient use of medications. Conditions were documented within patients ' medical records the dosing switch resulted in similar adverse-effect profiles II receptor antagonist versus... You full coverage throughout the day and 50mg a day with irbesartan work than. An equivalent dosage of an alternative angiotensin II receptor antagonist criteria for use veteran! ( length of time it works for ) at lower dosages than valsartan to replace it with an equivalent of... Versus other antihypertensive drug classes, Wells BG, Posey LM, eds 5 1... 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