From the Guidelines
Avalide (irbesartan/hydrochlorothiazide) is contraindicated in patients with a history of hypersensitivity to either irbesartan or hydrochlorothiazide, anuria, pregnancy, severe renal impairment (GFR <30 mL/min), and those taking aliskiren or with refractory hyponatremia, hypercalcemia, or symptomatic hyperuricemia.
Contraindications for Avalide
The following are contraindications for Avalide:
- History of hypersensitivity to irbesartan, hydrochlorothiazide, or sulfonamide-derived drugs 1
- Anuria (inability to urinate)
- Pregnancy, especially in the second and third trimesters, due to the risk of fetal harm or death 1
- Severe renal impairment (GFR <30 mL/min)
- Severe hepatic impairment, which requires caution when using Avalide
- Diabetic patients taking aliskiren, due to increased risk of adverse effects
- Refractory hyponatremia, hypercalcemia, or symptomatic hyperuricemia, which may be worsened by the hydrochlorothiazide component
- Systemic lupus erythematosus, as Avalide may exacerbate this condition
- Electrolyte imbalances and metabolic changes, which require careful monitoring, especially in elderly patients or those with heart failure or liver disease 1
Important Considerations
When prescribing Avalide, it is essential to consider the following:
- Monitor for hyponatremia and hypokalemia, uric acid and calcium levels 1
- Avoid using Avalide in combination with ARBs or direct renin inhibitors 1
- Use caution in patients with a history of acute gout, unless the patient is on uric acid–lowering therapy 1
- Avoid using Avalide in patients with severe bilateral renal artery stenosis, due to the risk of acute renal failure 1
- Do not use Avalide in patients with a history of angioedema with ACE inhibitors or ARBs 1
From the FDA Drug Label
Hydrochlorothiazide capsules are contraindicated in patients with anuria. Hypersensitivity to this product or other sulfonamide derived drugs is also contraindicated. Irbesartan tablets are contraindicated in patients who are hypersensitive to any component of this product. Do not co-administrate aliskiren with irbesartan tablets in patients with diabetes.
The contraindications for Avalide (which is a combination of hydrochlorothiazide and irbesartan) are:
- Anuria 2
- Hypersensitivity to hydrochlorothiazide, other sulfonamide derived drugs, or any component of irbesartan 2 3
- Co-administration with aliskiren in patients with diabetes 3
From the Research
Contraindications for Avalide
Avalide is a combination medication containing irbesartan and hydrochlorothiazide, used to treat high blood pressure. The contraindications for Avalide can be inferred from the properties of its components.
- Irbesartan is an angiotensin II receptor antagonist, and its use is contraindicated in patients with known hypersensitivity to irbesartan or other angiotensin II receptor antagonists 4, 5, 6.
- Hydrochlorothiazide is a thiazide diuretic, and its use is contraindicated in patients with anuria, hypersensitivity to hydrochlorothiazide or other sulfonamide-derived drugs, and in patients with a history of renal impairment or hepatic coma 7, 8.
Special Precautions
Some special precautions should be taken when using Avalide:
- Patients with renal impairment: Irbesartan has been shown to be effective in reducing blood pressure in patients with chronic renal disease, but its use should be monitored closely in patients with severe renal impairment 4, 5.
- Patients with volume depletion: Volume depletion should be corrected before initiating irbesartan therapy, as it may cause an exaggerated response to the initial dose 5.
- Patients with hyperkalemia: Irbesartan may increase potassium levels, and its use should be monitored closely in patients with hyperkalemia 4.
Interactions
Avalide may interact with other medications, including: