Perioperative Management of Edarbyclor Before Elective Surgery
For patients taking edarbyclor (azilsartan medoxomil/chlorthalidone) before elective surgery, discontinue the medication 24 hours before the procedure to minimize the risk of intraoperative hypotension, particularly during anesthetic induction.
Rationale for Discontinuation
Edarbyclor contains azilsartan medoxomil, an angiotensin II receptor blocker (ARB), combined with chlorthalidone, a thiazide-like diuretic. The ARB component poses specific perioperative risks:
ARBs should be held 24 hours before surgery based on evidence showing that continuation increases the risk of severe hypotensive episodes during anesthetic induction 1, 2.
A randomized study demonstrated that patients who continued ARBs on the morning of surgery experienced significantly more hypotensive episodes (2±1 vs 1±1 episodes), longer duration of hypotension (8±7 vs 3±4 minutes), and greater need for vasopressor support compared to those who discontinued therapy the day before 2.
Recent cohort evidence confirms that patients who stopped ACE inhibitors or ARBs 24 hours before noncardiac surgery had lower rates of the composite outcome (all-cause death, stroke, or myocardial injury) and less intraoperative hypotension than those continuing these medications 1.
Bleeding Risk Considerations
Unlike anticoagulants or antiplatelet agents, edarbyclor does not require extended discontinuation based on surgical bleeding risk:
The 24-hour discontinuation period applies to both low and high bleeding risk procedures, as the primary concern is hemodynamic instability rather than bleeding 1, 2.
This differs from antiplatelet agents (which require 5-7 days discontinuation for high-risk procedures) and DOACs (which require 2-3 days for high-risk procedures) 1.
Postoperative Resumption
Resume edarbyclor once the patient is hemodynamically stable and able to take oral medications, typically within 24 hours after surgery if blood pressure control is adequate and there are no concerns about hypotension 1.
Ensure adequate intravascular volume status before resumption, as the combination of an ARB and diuretic can precipitate hypotension in volume-depleted postoperative patients 1.
Critical Caveats
Do not abruptly discontinue if the patient has been taking edarbyclor for heart failure with reduced ejection fraction or post-myocardial infarction, as these represent guideline-directed medical therapy indications where continuation may be warranted despite perioperative risks 1.
Assess renal function and electrolytes preoperatively, as the chlorthalidone component can cause hypokalemia and hypomagnesemia, which increase perioperative arrhythmia risk 1.
If blood pressure is severely elevated (DBP ≥110 mmHg) at preoperative assessment, consider delaying elective surgery for gradual blood pressure reduction, as this level of hypertension increases risk of cardiovascular complications including dysrhythmias, myocardial ischemia, and renal failure 1.
For patients unable to take oral medications postoperatively, use intravenous antihypertensive agents to maintain blood pressure control rather than leaving hypertension untreated 1.