Hydrochlorothiazide/irbesartan Disease Interactions
There are 15 disease interactions with hydrochlorothiazide / irbesartan.
- Hypotension
- Anuria
- Electrolyte losses
- Liver disease
- Lupus erythematosus
- Renal function disorders
- CHF
- Hyperkalemia
- Renal impairment
- Asthma
- Diabetes
- Hyperlipidemia
- Hyperparathyroidism
- Hyperuricemia
- Thyroid function tests
AR antagonists (applies to hydrochlorothiazide/irbesartan) hypotension
Major Potential Hazard, High plausibility. Applicable conditions: Dehydration, hemodialysis, Hyponatremia
Angiotensin II receptor (AR) antagonists can cause symptomatic hypotension in patients with an activated renin-angiotensin system, such as volume- and/or sodium-depleted patients. Therapy with AR antagonists should be administered cautiously in such patients and in those predisposed to hypovolemic or hyponatremic states (e.g., patients on diuretic therapy, especially if high doses were used or if recently instituted; those on dietary salt restriction; renal dialysis patients). Volume and/or sodium depletion should be corrected prior to initiating therapy with AR antagonists, and the patient should be hemodynamically stable. Ideally, patients at risk for excessive hypotension should initiate AR antagonist therapy under close medical supervision, preferably with a lower dose, and followed closely for the first 2 weeks of treatment and whenever the dosage of AR antagonist or diuretic is increased.
Thiazides (applies to hydrochlorothiazide/irbesartan) anuria
Major Potential Hazard, High plausibility.
The use of thiazide diuretics is contraindicated in patients with anuria.
Thiazides (applies to hydrochlorothiazide/irbesartan) electrolyte losses
Major Potential Hazard, High plausibility. Applicable conditions: Hypokalemia, Diarrhea, Electrolyte Abnormalities, Hyperaldosteronism, Hyponatremia, Magnesium Imbalance, Malnourished, Vomiting, Ventricular Arrhythmia, Dehydration
The use of thiazide diuretics is commonly associated with loss of electrolytes, most significantly potassium but also sodium, chloride, bicarbonate, and magnesium. The loss of other electrolytes such as phosphate, bromide and iodide is usually slight. Potassium and magnesium depletion may lead to cardiac arrhythmias and cardiac arrest. Other electrolyte-related complications include metabolic alkalosis and hyponatremia, which are rarely life-threatening. Therapy with thiazide diuretics should be administered cautiously in patients with or predisposed to fluid and electrolyte depletion, including patients with primary or secondary aldosteronism (may have low potassium levels); those with severe or prolonged diarrhea or vomiting; and those with poor nutritional status. Fluid and electrolyte abnormalities should be corrected prior to initiating therapy, and blood pressure as well as serum electrolyte concentrations monitored periodically and maintained at normal ranges during therapy. Patients should be advised to immediately report signs and symptoms of fluid or electrolyte imbalance, including dry mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, arrhythmia, or gastrointestinal disturbances such as nausea and vomiting. Digitalized patients and patients with a history of ventricular arrhythmias should be monitored carefully, since development of hypokalemia may be particularly dangerous in these patients. The risk of hypokalemia may be minimized by slow diuresis, a lower thiazide dosage, potassium supplementation, or combined use with a potassium-sparing diuretic.
Thiazides (applies to hydrochlorothiazide/irbesartan) liver disease
Major Potential Hazard, High plausibility.
Patients with severe liver disease or cirrhosis are very susceptible to thiazide-induced hypokalemic hypochloremic alkalosis. Blood ammonia concentrations may be further increased in patients with previously elevated concentrations. Hepatic encephalopathy and death have occurred secondary to the electrolyte alterations accompanying diuretic use. Therapy with thiazide diuretics should be administered cautiously in patients with impaired hepatic function or progressive liver disease, and discontinued promptly if signs of impending hepatic coma appear (e.g., tremors, confusion, and increased jaundice).
Thiazides (applies to hydrochlorothiazide/irbesartan) lupus erythematosus
Major Potential Hazard, Moderate plausibility.
The use of thiazide diuretics has been reported to possibly exacerbate or activate systemic lupus erythematosus. Reported cases have generally been associated with chlorothiazide and hydrochlorothiazide. Therapy with thiazide diuretics should be administered cautiously in patients with a history or risk of SLE.
Thiazides (applies to hydrochlorothiazide/irbesartan) renal function disorders
Major Potential Hazard, High plausibility. Applicable conditions: Renal Dysfunction
Thiazide diuretics may be ineffective when the glomerular filtration rate is low (GFR < 25 mL/min) because they are not expected to be filtered into the renal tubule, their site of action. In addition, thiazide diuretics decrease the GFR and may precipitate azotemia in renal disease. Cumulative effects may also develop because most of these drugs are excreted unchanged in the urine by glomerular filtration and active tubular secretion. Therapy with thiazide diuretics should be administered cautiously at reduced dosages in patients with renal impairment. If renal function becomes progressively worse, as indicated by rising BUN or serum creatinine levels, an interruption or discontinuation of thiazide therapy should be considered.
AR antagonists (applies to hydrochlorothiazide/irbesartan) CHF
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Congestive Heart Failure
Angiotensin II receptor (AR) antagonists can cause renal impairment in patients whose renal function depends on the activity of the renin-angiotensin-aldosterone system. In addition, symptomatic hypotension can occur in susceptible individuals, which may compromise renal and myocardial perfusion. In patients with severe congestive heart failure (CHF), treatment with AR antagonists has been associated with oliguria and/or progressive azotemia and, rarely, renal failure, myocardial ischemia, and death. Therapy with AR antagonists should be initiated cautiously in patients with severe CHF, especially when accompanied by volume and/or sodium depletion. In patients who experience a decline in renal function, discontinuation of AR antagonist therapy is usually not required provided there is symptomatic improvement of the heart failure and renal deterioration is well-tolerated. Transient hypotension is also not a contraindication to further treatment with AR antagonists, since therapy can usually be reinstated without difficulty after blood pressure stabilizes.
AR antagonists (applies to hydrochlorothiazide/irbesartan) hyperkalemia
Moderate Potential Hazard, Moderate plausibility.
Drugs that inhibit the renin-angiotensin, such as angiotensin II receptor antagonist system can cause hyperkalemia. Concomitant use of these agents with drugs that increase potassium levels may increase the risk of hyperkalemia. Use caution when using these agents together and monitor serum potassium periodically.
AR antagonists (applies to hydrochlorothiazide/irbesartan) renal impairment
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction
Changes in renal function including acute renal failure can be caused by drugs that inhibit the renin-angiotensin system and by diuretics. Patients whose renal function may depend in part on the activity of the renin-angiotensin system (e.g., patients with renal artery stenosis, chronic kidney disease, severe congestive heart failure, or volume depletion) may be at particular risk of developing acute renal failure with these agents. Monitor renal function periodically in these patients. Consider withholding or discontinuing therapy in patients who develop a clinically significant decrease in renal function with these agents.
Thiazides (applies to hydrochlorothiazide/irbesartan) asthma
Moderate Potential Hazard, Moderate plausibility.
Thiazide diuretics should be used with caution in patients with history of bronchial asthma as sensitivity reactions may occur.
Thiazides (applies to hydrochlorothiazide/irbesartan) diabetes
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus, Abnormal Glucose Tolerance
Thiazide diuretics may cause hyperglycemia and glycosuria in patients with diabetes. They may also precipitate diabetes in prediabetic patients. These effects are usually reversible following discontinuation of the drugs. Therapy with thiazide diuretics should be administered cautiously in patients with diabetes mellitus, glucose intolerance, or a predisposition to hyperglycemia. Patients with diabetes mellitus should be monitored more closely during thiazide therapy, and their antidiabetic regimen adjusted accordingly.
Thiazides (applies to hydrochlorothiazide/irbesartan) hyperlipidemia
Moderate Potential Hazard, Moderate plausibility.
Thiazide diuretics may increase serum triglyceride and cholesterol levels, primarily LDL and VLDL. Whether these effects are dose-related and sustained during chronic therapy are unknown. Patients with preexisting hyperlipidemia may require closer monitoring during thiazide therapy, and adjustments made accordingly in their lipid-lowering regimen
Thiazides (applies to hydrochlorothiazide/irbesartan) hyperparathyroidism
Moderate Potential Hazard, Moderate plausibility.
Urinary calcium excretion is decreased by thiazide diuretics during chronic administration. Pathologic changes in the parathyroid gland with hypercalcemia and hypophosphatemia have been reported during prolonged therapy. However, the common complications of hyperparathyroidism such as renal lithiasis, bone resorption, and peptic ulceration have not been seen. Clinicians should be cognizant of these effects when prescribing or administering thiazide therapy to patients with hyperparathyroidism. These drugs should be discontinued before carrying out tests for parathyroid function.
Thiazides (applies to hydrochlorothiazide/irbesartan) hyperuricemia
Moderate Potential Hazard, High plausibility. Applicable conditions: Gout
Thiazide diuretics decrease the rate of uric acid excretion. Hyperuricemia occurs frequently but is usually asymptomatic and rarely leads to clinical gout except in patients with a history of gout or chronic renal failure. Therapy with thiazide diuretics should be administered cautiously in such patients.
Thiazides (applies to hydrochlorothiazide/irbesartan) thyroid function tests
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Thyroid Disease
Thiazide diuretics may decrease serum PBI (protein-bound iodine) levels without associated thyroid disturbance. Clinicians should be cognizant of this effect when prescribing or administering thiazide therapy to patients with thyroid disorders.
Hydrochlorothiazide/irbesartan drug interactions
There are 527 drug interactions with hydrochlorothiazide / irbesartan.
Hydrochlorothiazide/irbesartan alcohol/food interactions
There are 3 alcohol/food interactions with hydrochlorothiazide / irbesartan.
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Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
No interaction information available. |
Further information
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