Fixed-dose combination: angiotensin II receptor blocker plus thiazide diuretic
ATC code: C09DA04 (Irbesartan and diuretics)
Irbesartan is a non-peptide selective AT1 receptor blocker. T½ 11-15 h gives 24-hour BP reduction with once-daily dosing. Hydrochlorothiazide excretes sodium and water through distal tubules. In type 2 diabetes with microalbuminuria, irbesartan slows progression of diabetic nephropathy (IRMA-2, IDNT trials).
Second line
Essential hypertension uncontrolled on irbesartan monotherapy. Per ESH/ 2023 and SEH-LELHA 2023 – second-line. Dose: 150/12.5, 300/12.5, 300/25 mg once daily. Full effect at 6-8 weeks. Especially useful in patients with hypertension and type 2 diabetes due to irbesartan's renoprotective effect.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Contraindicated from the 2nd trimester. ARBs and ACE inhibitors cause fetopathy: oligohydramnios, fetal renal failure, skull hypoplasia, limb contractures. In women of reproductive age planning pregnancy, switch in advance to methyldopa, labetalol, or slow-release nifedipine (ACOG 222 (2020), SEGO 2023).
Milk excretion data for the fixed combination are limited. For breastfeeding ESH 2023 and ACOG 2020 recommend switching to enalapril (RID 0.2%), captopril (RID 0.02%), methyldopa, or labetalol.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Irbesartan + Hydrochlorothiazide is evaluated for the following indications with varying evidence strength: Hypertension (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Irbesartan + Hydrochlorothiazide (≥ 1 in 100): Dizziness, Hypotension, Hyperkalemia, Hyponatremia, Hyperuricemia, Elevated creatinine. See the Safety section for uncommon and serious reactions.
FDA category D. Contraindicated from the 2nd trimester. ARBs and ACE inhibitors cause fetopathy: oligohydramnios, fetal renal failure, skull hypoplasia, limb contractures. In women of reproductive age planning pregnancy, switch in advance to methyldopa, labetalol, or slow-release nifedipine (ACOG 222 (2020), SEGO 2023).
Milk excretion data for the fixed combination are limited. For breastfeeding ESH 2023 and ACOG 2020 recommend switching to enalapril (RID 0.2%), captopril (RID 0.02%), methyldopa, or labetalol.
Irbesartan + Hydrochlorothiazide is contraindicated in: Hypersensitivity to sartan, thiazides, or sulfonamides; Pregnancy (2nd-3rd trimester); Bilateral renal artery stenosis; Severe renal impairment (CrCl <30 for the thiazide component); Severe hepatic impairment, cholestasis. Full list in the Safety section.