Medical term:

Teveten

eprosartan mesylate

Teveten

Pharmacologic class: Angiotensin II receptor antagonist

Therapeutic class: Antihypertensive

Pregnancy risk category C (first trimester), D (second and third trimesters)

Action

Blocks aldosterone-stimulating and vasoconstrictive effects of angiotensin II at receptor sites in vascular smooth muscles and adrenal glands, decreasing vascular resistance

Availability

Tablets: 400 mg, 600 mg

Indications and dosages

➣ Hypertension

Adults: 600 mg P.O. once daily or in divided doses b.i.d. Total daily dosage range is 400 to 800 mg.

Contraindications

• Hypersensitivity to drug or its components

• Pregnancy or breastfeeding

Precautions

Use cautiously in:

• hypotension, heart failure, renal or hepatic impairment, obstructive biliary disorders, volume or sodium depletion

• concurrent high-dose diuretic therapy

• females of childbearing age

• children younger than age 18 (safety not established).

Administration

• Give initial dose in supervised medical setting, and monitor blood pressure for 2 hours after administration.

• Know that drug may be given alone or with other antihypertensives.

• Be aware that black patients have a higher risk of angioedema.

• Be prepared to treat transient hypotension by placing patient in supine position and giving I.V. normal saline infusion as needed.

Adverse reactions

CNS: dizziness, fatigue, headache, syncope

CV: hypotension, chest pain, peripheral edema

EENT: sinus disorders

GI: nausea, diarrhea, constipation, abdominal pain, dry mouth

GU: albuminuria, renal failure

Hepatic: hepatitis

Metabolic: gout, hyperkalemia

Musculoskeletal: joint pain, back pain, muscle weakness

Respiratory: upper respiratory tract infection, cough, bronchitis

Skin: angioedema

Other: dental pain, fever, facial edema

Interactions

Drug-drug. Antihypertensives, diuretics: increased risk of hypotension

Nonsteroidal anti-inflammatory drugs: decreased antihypertensive effect of eprosartan

Potassium-sparing diuretics, potassium supplements: increased risk of hyperkalemia

Drug-diagnostic tests. Absolute neutrophil count, hemoglobin, platelets, white blood cells: decreased

Albumin, creatinine, liver function tests, serum BUN: elevated levels

Drug-food. Salt substitutes containing potassium: increased risk of hyperkalemia

Drug-herbs. Ephedra (ma huang): antagonism of eprosartan action

Drug-behaviors. Alcohol use: increased CNS depression

Patient monitoring

• Monitor vital signs, particularly for hypotension after administration.

• Assess cardiovascular status, especially for chest pain, syncope, and edema.

• Monitor liver and kidney function test results, watching for drug-induced hepatitis or renal failure.

• Assess respiratory status. Stay alert for dry, persistent cough and signs and symptoms of respiratory infections.

• Monitor electrolyte levels, and watch for signs and symptoms of hyperkalemia.

Patient teaching

• Instruct patient to take drug at same time each day, with or without food.

☞ Inform patient that drug may cause angioedema. Instruct him to immediately report facial or lip swelling, fever, or sore throat.

☞ Advise patient to immediately report chest pain, fainting, decreased urine output, unusual tiredness, yellowing of skin or eyes, or swelling.

☞ Tell female patient to contact prescriber right away if she suspects she's pregnant.

• Caution female not to breastfeed while taking drug.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.

eprosartan

(ep-roe-sar-tan) ,

Teveten

(trade name)

Classification

Therapeutic: antihypertensives
Pharmacologic: angiotensin ii receptor antagonists

Pregnancy Category: D

Indications

Alone or with other agents in the management of hypertension.

Action

Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II at various receptor sites, including vascular smooth muscle and the adrenal glands.

Therapeutic effects

Lowering of BP in patients with hypertension.

Pharmacokinetics

Absorption: 13% absorbed following oral administration.

Distribution: Crosses the placenta.

Protein Binding: 98%.

Metabolism and Excretion: Excreted mostly unchanged in feces via biliary excretion.

Half-life: 20 hr.

Time/action profile (antihypertensive effect with chronic dosing)

ROUTE	ONSET	PEAK	DURATION
PO	within 1–2 hr	2–3 wksr	24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Concurrent use with aliskiren in patients with diabetes or moderate-to-severe renal impairment (CCr <60 mL/min) Obstetric: Can cause injury or death of fetus – if pregnancy occurs, discontinue immediately. Lactation: Discontinue drug or use formula.

Use Cautiously in: Volume- or salt-depleted patients or patients receiving large doses of diuretics (correct deficits before initiating therapy); genetic implication Black patients (may not be as effective); Impaired renal function caused by primary renal disease or heart failure (may worsen renal function); Women of childbearing potential; Pediatric: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

depression
fatigue

Cardiovascular

hypotension

Ear, Eye, Nose, Throat

pharyngitis
rhinitis

Fluid and Electrolyte

hyperkalemia

Gastrointestinal

abdominal pain

Genitourinary

impaired renal function

Musculoskeletal

pain

Miscellaneous

angioedema (life-threatening)

Interactions

Drug-Drug interaction

Additive hypotension with other antihypertensives.Excessive hypotension may occur with concurrent use of diuretics.↑ risk of hyperkalemia with concurrent use of potassium supplements,potassium-containing salt substitutes, or potassium-sparing diuretics.↑ risk of hyperkalemia, renal dysfunction, hypotension, and syncope with concurrent use of ACE inhibitors or aliskiren ; avoid concurrent use with aliskiren in patients with diabetes or CCr <60 mL/minNSAIDs and selective COX-2 inhibitors may blunt the antihypertensive effect and ↑ the risk of renal dysfunction.

Route/Dosage

Oral (Adults) 600 mg once daily when used as monotherapy in patients who are not volume depleted; may be ↑ to 800 mg/day (in 1–2 divided doses).

Renal Impairment

Oral (Adults) CCr <60 mL/min—Do not exceed 600 mg/day.

Availability (generic available)

Tablets: 400 mg, 600 mg

In combination with: hydrochlorothiazide (Teveten HCT; see combination drugs).

Nursing implications

Nursing assessment

Assess BP (lying, sitting, standing) and pulse frequently during initial dosage adjustment and periodically throughout therapy. Notify health care professional of significant changes.
Monitor frequency of prescription refills to determine compliance.
Assess patients for signs of angioedema (dyspnea, facial swelling). May rarely cause angioedema.
Lab Test Considerations: Monitor renal function. May cause increase in BUN and serum creatinine.
- May cause hyperkalemia.
- May cause elevated AST, ALT, and alkaline phosphatase.
- May cause slight decrease in hemoglobin, neutropenia, or thrombocytopenia.

Potential Nursing Diagnoses

Risk for injury (Adverse Reactions)
Noncompliance (Patient/Family Teaching)

Implementation

Volume depletion should be corrected, if possible, before initiation of therapy.
Oral: May be administered without regard to meals.

Patient/Family Teaching

Emphasize the importance of continuing to take as directed, even if feeling well. Take missed doses as soon as remembered if not almost time for next dose; do not double doses. Instruct patient to take medication at the same time each day. Warn patient not to discontinue therapy unless directed by health care professional.
Caution patient to avoid salt substitutes containing potassium or foods containing high levels of potassium or sodium unless directed by health care professional. See.
Encourage patient to comply with additional interventions for hypertension (weight reduction, low-sodium diet, discontinuation of smoking, moderation of alcohol consumption, regular exercise, stress management). Medication controls but does not cure hypertension.
Instruct patient and family on proper technique for monitoring BP. Advise them to check BP at least weekly and to report significant changes.
Caution patient to avoid sudden changes in position to decrease orthostatic hypotension. Use of alcohol, standing for long periods, exercising, and hot weather may increase orthostatic hypotension.
May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially cough, cold, or allergy remedies.
Instruct patient to notify health care professional of medication regimen before treatment or surgery.
Instruct patient to notify health care professional if swelling of face, eyes, lips, or tongue or if difficulty swallowing or breathing occur.
Advise women of childbearing age to use contraception and notify health care professional if pregnancy is suspected or planned, or if breastfeeding. If pregnancy is detected, discontinue medication as soon as possible. Avoid breastfeeding.
Emphasize the importance of follow-up exams to evaluate effectiveness of medication.

Evaluation/Desired Outcomes

Decrease in BP without appearance of excessive side effects.

Teveten

(tĕv′ĭ-tn)

A trademark for the drug eprosartan mesylate.

Teveten®

Eprosartan mesylate, see there.

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