Consumer medicine information

Karvea

Irbesartan

BRAND INFORMATION

Brand name

Karvea

Active ingredient

Irbesartan

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using Karvea.

What is in this leaflet

This leaflet answers some common questions about Karvea.

It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.

All medicines have benefits and risks. Your doctor has weighed the benefits of you taking this medicine against the risks it will have for you.

If you have any concerns about taking this medicine, ask your doctor or pharmacist.

Keep this leaflet with your medicine. You may need to read it again.

What Karvea is used for

Karvea is used to lower high blood pressure, which doctors call hypertension.

Everyone has blood pressure. This pressure helps get your blood all around your body. Your blood pressure may be different at different times of the day, depending on how busy or worried you are. You have hypertension (high blood pressure) when your blood pressure stays higher than is needed, even when you are calm and relaxed.

There are often no symptoms of high blood pressure. The only way of knowing that you have high blood pressure is to have your blood pressure checked on a regular basis. If high blood pressure is not treated it can lead to serious health problems, such as stroke, heart disease and kidney failure. Karvea is also used in the treatment of kidney disease in patients with high blood pressure and type 2 diabetes.

How Karvea works

Karvea belongs to a group of medicines known as angiotensin-II receptor antagonists. Angiotensin II is a substance produced in the body that causes blood vessels to narrow. Karvea blocks angiotensin-II and therefore widens your blood vessels, making it easier for your heart to pump blood throughout your body. This helps to lower your blood pressure.

Karvea also slows the decrease of kidney function in patients with high blood pressure and type 2 diabetes.

Your doctor may have prescribed Karvea for another reason. Ask your doctor if you have any questions about why Karvea has been prescribed for you.

This medicine is only available with a doctor's prescription.

There is no evidence that this medicine is addictive.

Before you take Karvea

When you must not take it

Do not take Karvea if:

  • you are pregnant (or think you may be pregnant) or are planning to become pregnant;
    Karvea may affect your developing baby if you take it during pregnancy.
  • you are breast-feeding;
    It is not known if Karvea passes into breast milk, therefore it is recommended that you not take it while you are breast-feeding;
  • you are allergic to irbesartan or to any of the ingredients listed at the end of this leaflet;
  • you are diabetic or have kidney problems and are being treated with an ACE inhibitor, any aliskiren-containing medicines or a group of medicines known as AIIRAs (medicines also used to treat high blood pressure);
  • the packaging is torn or shows signs of tampering;
  • the expiry date on the pack has passed;
    If you take this medicine after the expiry date has passed, it may not work.

If you are not sure if you should start taking Karvea, talk to your doctor.

Karvea should not be given to children.

Before you start to take it

Tell your doctor if you have any allergies to:

  • any of the ingredients listed at the end of this leaflet, including lactose monohydrate
  • any other medicines
  • any other substances, such as foods, preservatives or dyes

Tell your doctor if you are pregnant or intend to become pregnant.

Tell your doctor if you are breast feeding or plan to breastfeed.

Tell your doctor if you have or have had any medical conditions, especially the following:

  • recent excessive vomiting or diarrhoea;
  • kidney problems, or you have had a kidney transplant or dialysis
  • heart problems,
  • liver problems, or have had liver problems in the past
  • high levels of potassium in your blood
  • you are strictly restricting your salt intake.

Tell your doctor if you plan to have surgery (even at the dentist) that needs a general anaesthetic.

If you have not told your doctor about any of the above, tell them before you take Karvea.

Taking other medicines

Tell your doctor if you are taking any other medicines, including any that you buy without a prescription from your pharmacy, supermarket or health food shop.

Some medicines may affect the way others work. Also, some other medicines used to treat high blood pressure may have an additive effect with Karvea in lowering blood pressure. This may happen with diuretics (fluid tablets). As a result you may need different amounts of your medicines.

It is important to tell your doctor if you are taking or plan to take any of the following:

  • potassium supplements, potassium-containing salt substitutes (you may need to have blood tests done regularly)
  • diuretics (fluid tablets)
  • medicines containing lithium (you may need to have blood tests done regularly).
  • anti-inflammatory medicines such as non-steroidal anti-inflammatory agents (for example diclofenac, ibuprofen) and COX-2 inhibitors (for example celecoxib) used to relieve pain, swelling and other symptoms of inflammation including arthritis. Taking Karvea and an anti-inflammatory medicine alone or with a thiazide diuretic (fluid tablet) may damage your kidneys. It may also reduce the effect Karvea has on lowering blood pressure.

Your doctor and pharmacist may have more information on medicines to be careful with or avoid while taking Karvea.

How to take Karvea

How much to take

Your doctor will tell you how many tablets to take each day.

Usually patients start with one 150 mg tablet once a day. However, some patients may need a lower starting dose. Your doctor will tell you if this is necessary. The full blood pressure lowering effect of Karvea should be reached about 4-6 weeks after starting treatment.

Depending on how your blood pressure responds, your daily dose of Karvea may need to be increased. Most patients take either 150 mg or 300 mg each day.

In patients with high blood pressure and type 2 diabetes, 300 mg once daily is the preferred maintenance dose for slowing the progression of associated kidney disease.

Ask your doctor or pharmacist if you are unsure of the correct dose for you. They will tell you exactly how much to take.

Follow the instructions they give you.

How to take it

Swallow the tablet whole with a glass of water.

It does not matter whether you take Karvea tablets before or after food.

When to take it

Take Karvea at about the same time each day. Taking your tablets at the same time each day will have the best effect. It will also help you remember when to take the tablets.

How long to take it

Continue taking Karvea until your doctor tells you to stop.

Karvea helps to control your high blood pressure, but it does not cure it. Therefore Karvea must be taken every day.

To help you remember to take your tablets each day, Karvea tablets are supplied in a Calendar pack with the foil backing marked with the days of the week. This is just a way to help you to remember to take your tablets. All of the tablets in the pack are the same.

When you start a new strip of tablets, take the tablet marked "START" at the end of the blister strip. On the next day, take the tablet marked with the relevant day of the week.

Continue taking your tablets each day until all of the tablets are taken. Commence the next strip at "START" and continue as before.

If you forget to take it

If it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to. Otherwise, take it as soon as you remember, and go back to taking your tablets as you would normally.

Do not take a double dose to make up for the dose you missed. This may increase the chance of you getting any unwanted side effects.

If you are not sure what to do, ask your doctor or pharmacist.

If you have trouble remembering to take your tablets, ask your pharmacist for some hints.

If you take too much (overdose)

Immediately telephone your doctor or Poisons Information Centre (telephone: 13 11 26) or go to Accident and Emergency at your nearest hospital, if you think that you or anyone else may have taken too much Karvea. Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention.

If you take too many Karvea tablets you will probably feel light-headed or dizzy.

While you are using Karvea

Things you must do

Tell any other doctors, dentists, and pharmacists who are treating you that you are taking Karvea.

If you become pregnant while taking Karvea tell your doctor immediately.

Have your blood pressure checked when your doctor tells you to, to make sure Karvea is working.

If you are about to be started on any new medicine, tell your doctor and pharmacist that you are taking Karvea.

If you plan to have surgery that needs a general anaesthetic, tell your doctor or dentist that you are taking Karvea. Your blood pressure may drop suddenly.

Make sure you drink enough water during exercise and hot weather when you are taking Karvea, especially if you sweat a lot. If you do not drink enough water while taking Karvea, you may faint or feel light-headed or sick. This is because your body does not have enough fluid and your blood pressure is low. If you continue to feel unwell, tell your doctor.

If you have excessive vomiting and/or diarrhoea while taking Karvea, tell your doctor. You may lose too much water and salt and your blood pressure may drop too much.

If you feel light headed or dizzy after taking your first dose of Karvea, or when your dose is increased, tell your doctor immediately.

Things you must not do

Do not give Karvea tablets to anyone else, even if they have the same condition as you.

Do not take Karvea to treat any other complaints unless your doctor or pharmacist tells you to.

Do not stop taking Karvea, or lower the dosage, without checking with your doctor.

Things to be careful of

If you feel light-headed, dizzy or faint when getting out of bed or standing up, get up slowly. Standing up slowly, especially when you get up from bed or chairs, will help your body get used to the change in position and blood pressure. If this problem continues or gets worse, talk to your doctor.

Be careful driving or operating machinery until you know how Karvea affects you.

As with many other medicines used to treat high blood pressure, Karvea may cause dizziness or light-headedness in some people.

If this occurs do not drive.

Make sure you know how you react to Karvea before you drive a car, operate machinery or do anything else that could be dangerous if you are dizzy or light-headed.

If you drink alcohol, dizziness or light-headedness may be worse.

Things that would be helpful for lowering your blood pressure

Some self help measures suggested below may help your condition. Talk to your doctor or pharmacist about these measures and for more information.

  • Alcohol -
    your doctor may advise you to limit your alcohol intake.
  • Weight -
    if you are overweight, your doctor may suggest losing some weight to help lower your blood pressure and help lessen the amount of work your heart has to do. Some people may need a dietician's help to lose weight.
  • Diet -
    your doctor may advise you to eat a healthy low-fat diet which includes plenty of fresh vegetables, fruit, bread, cereals and fish.
  • Salt -
    your doctor may advise you to watch the amount of salt in your diet. To reduce your salt intake you should avoid using salt in cooking or at the table.
  • Exercise -
    regular exercise helps to reduce blood pressure and helps get the heart fitter, but it is important not to overdo it. Walking is good exercise, but try to find a route that is reasonably flat. Before starting any exercise, ask your doctor about the best kind of programme for you.
  • Smoking -
    your doctor may advise you to stop smoking or at least cut down.

Side effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking Karvea.

Karvea helps most people with high blood pressure, but it may have unwanted side effects in a few people. All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects.

Ask your doctor or pharmacist to answer any questions you may have.

Tell your doctor if you notice any of the following and they worry you:

  • headache
  • dizziness or light-headedness (vertigo)
  • unusual tiredness or weakness, fatigue
  • nausea/vomiting.

These are common side effects. They are generally mild and do not normally require treatment to be interrupted.

Tell your doctor immediately if you notice any of the following:

  • skin rash or itchiness
  • aching muscles, not caused by exercise
  • muscle pain or weakness
  • buzzing, ringing or other persistent noise in the ear
  • yellowing of the skin and/or eyes, also called jaundice
  • symptoms that may indicate kidney disease, such as passing little or no urine, drowsiness, nausea, vomiting, breathlessness, loss of appetite and weakness
  • symptoms that may indicate high potassium levels in the blood, such as nausea, diarrhoea, muscle weakness, change in heart rhythm
  • symptoms that may indicate liver disease such as nausea, vomiting, loss of appetite, feeling generally unwell, fever, itching, yellowing of the skin and eyes and dark coloured urine
  • symptoms that may indicate low platelet count such as easy or excessive bruising, bleeding from gums or nose, prolonged bleeding from cuts and blood in urine or stools.

These are serious side effects. Skin rash and itchiness may be symptoms of an allergic reaction. You may need medical attention.

These side effects are not common.

If any of the following happen, stop taking Karvea and either tell your doctor immediately or go to Accident and Emergency Department at your nearest hospital:

  • swelling of the face, lips, tongue or throat which may cause difficulty in swallowing or breathing;
  • severe and sudden onset of pinkish, itchy swellings on the skin, also called hives or nettlerash.

These are very serious side effects.

You may need urgent medical attention or hospitalisation.

These side effects are very rare.

Other side effects not listed above may occur in some patients. Tell your doctor or pharmacist if you notice anything that is making you feel unwell.

After using Karvea

Storage

Keep your Karvea tablets in the blister pack until it is time to take them. If you take the tablets out of the blister pack they may not keep well.

Keep Karvea tablets in a cool dry place where the temperature stays below 25 degrees C.

Do not store Karvea or any other medicine in the bathroom or near a sink. Do not leave them near a radiator, in a car on hot days or on a window sill. Heat and dampness can destroy some medicines.

Keep all medicines out of the reach of children. A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

Disposal

If your doctor tells you to stop taking Karvea or the tablets have passed their expiry date, ask your pharmacist what to do with any tablets that are left over.

Product description

What it looks like

Karvea 75 mg tablets: white, oval shaped film-coated tablets with a heart shape imprinted on one side and "2871" engraved on the other side. Blister pack sizes include: 3*, 5*, 7*, 14*, 28*, 30, 56* and 98* tablets. AUST R 101702.

Karvea 150 mg tablets: white, oval shaped film-coated tablets with a heart shape imprinted on one side and "2872" engraved on the other side. Blister pack sizes include: 3*, 5*, 7*, 14*, 28*, 30, 56* and 98* tablets. AUST R 101706.

Karvea 300 mg tablets: white, oval shaped film-coated tablets with a heart shape imprinted on one side and "2873" engraved on the other side. Blister pack sizes include: 3*, 5*, 7*, 14*, 28*, 30, 56* and 98* tablets. AUST R 101708.

* presentations currently not-marketed.

Active ingredients

Karvea 75 mg tablets: 75 mg irbesartan per tablet.

Karvea 150 mg tablets: 150 mg irbesartan per tablet.

Karvea 300 mg tablets: 300 mg irbesartan per tablet.

Other Ingredients

Karvea tablets also contain carnauba wax, croscarmellose sodium, hypromellose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, silicon dioxide, and OPADRY II complete film coating system 32F38977 WHITE.

Supplier

Karvea is supplied in Australia by:

sanofi-aventis australia pty ltd
12-24 Talavera Road
Macquarie Park, NSW 2113.

This leaflet was prepared in April 2020

Karvea is a registered trademark of sanofi-aventis.

karvea-ccdsv15-cmiv11-29apr20

Published by MIMS June 2020

BRAND INFORMATION

Brand name

Karvea

Active ingredient

Irbesartan

Schedule

S4

 

1 Name of Medicine

Irbesartan.

2 Qualitative and Quantitative Composition

Karvea 75 mg tablets contain 75 mg of irbesartan.
Karvea 150 mg tablets contain 150 mg of irbesartan.
Karvea 300 mg tablets contain 300 mg of irbesartan.

Excipients with known effect.

Contains sugars (as lactose monohydrate).
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

Karvea 75 mg tablets are white, biconvex oval shaped tablets, debossed with a heart on one side and with '2871' engraved on the other side.
Karvea 150 mg tablets are white, biconvex oval shaped tablets, debossed with a heart on one side and with '2872' engraved on the other side.
Karvea 300 mg tablets are white, biconvex oval shaped tablets, debossed with a heart on one side and with '2873' engraved on the other side.

4 Clinical Particulars

4.1 Therapeutic Indications

Karvea is indicated for the treatment of hypertension.
Karvea is indicated for delaying the progression of renal disease in hypertensive type II diabetics with persistent micro-albuminuria (≥ 30 mg per 24 hour) or urinary protein in excess of 900 mg per 24 hours.

4.2 Dose and Method of Administration

Irbesartan may be used either alone or in combination with other antihypertensive agents (e.g. thiazide diuretic, beta-adrenergic blocking agent, long-acting calcium-channel blocking agent).
The usual initial and maintenance dose of Karvea is 150 mg once daily. Karvea may be administered with or without food. Therapy should be adjusted according to blood pressure response. Patients requiring further reduction in blood pressure should have the dose increased to 300 mg once daily.
In patients with hypertension and type II diabetic renal disease, 300 mg of Karvea once daily is the preferred maintenance dose. Although irbesartan slowed the progression of renal disease in hypertensive patients separately to its effect on blood pressure, this does not remove the clinical requirement for a patient's blood pressure to be adequately controlled. If irbesartan alone is insufficient, then other agents should be added in order to gain blood pressure control.
Irbesartan increases the risk of significant hyperkalaemia in hypertensive patients with type II diabetes and moderate to severe renal insufficiency (see Section 4.8 Adverse Effects (Undesirable Effects); Section 4.4 Special Warnings and Precautions for Use, Laboratory test abnormalities, Hyperkalaemia). Serum potassium should be monitored regularly in such patients.
If blood pressure is not adequately controlled with Karvea alone, a diuretic (e.g. hydrochlorothiazide 12.5 mg daily) or another antihypertensive drug (e.g. beta-adrenergic blocking agent, long acting calcium channel blocking agent) may be added.

Patients with intravascular volume depletion.

Volume and/or sodium-depletion should be corrected before initiating therapy with irbesartan or a lower starting dose (e.g. 75 mg) should be considered. Patients undergoing haemodialysis should receive a starting dose of 75 mg and the dose should be adjusted according to BP response. If the blood pressure is not adequately controlled, the dose can be increased.

Elderly and patients with renal or hepatic impairment.

No dosage reduction is generally necessary in the elderly or in patients with impaired hepatic function (mild to moderate degree) or impaired renal function (regardless of degree), unless accompanied by uncorrected volume depletion (see Patients with intravascular volume depletion).

4.3 Contraindications

Karvea is contraindicated in patients who are hypersensitive to irbesartan or to any other component of the Karvea formulation.
Do not co-administer Karvea with aliskiren containing medicines in patients with diabetes or with moderate to severe renal impairment.
Do not co-administer Karvea with ACE inhibitors in patients with diabetic nephropathy.
Pregnancy (see Section 4.6 Fertility, Pregnancy and Lactation).

4.4 Special Warnings and Precautions for Use

Hypotension - volume-depleted patients.

Irbesartan has been rarely associated with hypotension in hypertensive patients without other co-morbid conditions. Symptomatic hypotension, as with ACE inhibitors, may be expected to occur in sodium/volume-depleted patients such as those treated vigorously with diuretics and/or salt restriction, or on haemodialysis. Volume and/or sodium-depletion should be corrected before initiating therapy with irbesartan or a lower starting dose (e.g. 75 mg) should be considered. Patients undergoing haemodialysis should receive a starting dose of 75 mg and the dose should be adjusted according to BP response.

Renal function.

As a consequence of inhibiting the renin-angiotensin-aldosterone system, changes in renal function may be anticipated in susceptible individuals. In patients whose renal function depends on the activity of the renin-angiotensin-aldosterone system (e.g. hypertensive patients with renal artery stenosis in one or both kidneys, or patients with severe congestive heart failure), treatment with drugs that affect this system has been associated with oliguria and/or progressive azotemia and (rarely) with acute renal failure and/or death. The possibility of a similar effect occurring with the use of an angiotensin II receptor antagonist, including irbesartan, cannot be excluded.
In hypertensive type II diabetic patients with proteinuria (≥ 900 mg/day), a population which has a high risk of renal artery stenosis, no patient treated with Karvea in IDNT had an early acute rise in serum creatinine attributable to renal artery disease (see Section 5.1 Pharmacodynamic Properties).
Experience is limited with irbesartan in patients with moderate to severe renal impairment; careful monitoring of renal function and potassium in such patients is advised.

Hyperkalaemia.

While hyperkalaemia in uncomplicated patients with hypertension has not been reported with irbesartan, hyperkalaemia may occur during treatment with other drugs that affect the renin-angiotensin-aldosterone system, especially in the presence of renal impairment and/or heart failure. Adequate monitoring of serum potassium in patients at risk is recommended.

Dual blockade of the renin-angiotensin-aldosterone system (RAAS).

Dual blockade of the RAAS by combining Karvea with an ACE inhibitor or with aliskiren is not recommended since there are increased risks of hypotension, hyperkalaemia, and changes in renal function compared to monotherapy. The use of Karvea in combination with aliskiren is contraindicated in patient with diabetes mellitus or renal impairment (see Section 4.3 Contraindications).
The use of Karvea in combination with an ACE inhibitor is contraindicated in patients with diabetic nephropathy (see Section 4.3 Contraindications; Section 4.5 Interactions with Other Medicines and Other Forms of Interactions).

Hypoglycemia.

Karvea may induce hypoglycaemia, particularly in patients treated for diabetes. Therefore, dose adjustment of antidiabetic treatment such as repaglinide or insulin may be required (see Section 4.8 Adverse Effects (Undesirable Effects)).

Psoriasis.

The use of Karvea in patients with psoriasis or a history of psoriasis should be carefully weighed as it may exacerbate psoriasis.

Cardiac disorders.

The safety of irbesartan in the presence of heart failure has not been fully defined. Sudden death has occurred in some studies of patients with heart failure, and although such deaths may have reflected the natural history of the underlying heart failure, caution is recommended when treating such patients with irbesartan.
At this time, experience is limited with irbesartan in the treatment of patients with ventricular dysfunction or cardiac arrhythmias; caution is advised.

Use in renal impairment.

See comments under Renal function, above.

Use in the elderly.

Among patients who received irbesartan in clinical studies, no overall differences in efficacy or safety were observed between older patients (65 years or older) and younger patients.

Paediatric use.

Safety and effectiveness in paediatric patients have not been established.

Effects on laboratory tests.

No clinically significant changes in laboratory test parameters occurred in controlled clinical studies of hypertension. No special monitoring of laboratory parameters is necessary for patients with uncomplicated essential hypertension. Monitoring of potassium levels and renal function is recommended for patients with heart failure and those with moderate to severe renal impairment (see Section 4.4 Special Warnings and Precautions for Use).
In two clinical studies of patients with hypertension and type II diabetic renal disease (IDNT and IRMA2) the following was reported.

Hyperkalaemia.

In IDNT the percent of subjects with hyperkalaemia (> 6 mmol/L) was 18.6% in the Karvea group compared to 6.0% in the placebo group. In IRMA 2 the percent of subjects with hyperkalaemia (> 6 mmol/L) was 1.0% in the Karvea groups and none in the placebo group. In IDNT discontinuations due to hyperkalaemia in the Karvea group were 2.1% vs 0.36% in the placebo group. In IRMA 2 discontinuations due to hyperkalaemia in the Karvea groups were 0.5% vs none in the placebo group.

4.5 Interactions with Other Medicines and Other Forms of Interactions

Based on in vitro data, no interactions would be expected to occur with drugs whose metabolism is dependent upon cytochrome P450 isoenzymes CYP1A1, CYP1A2, CYP2A6, CYP2B6, CYP2D6, CYP2E1 or CYP3A4. Irbesartan is primarily metabolised by CYP2C9, however, during clinical interaction studies, no significant pharmacodynamic interactions were observed when irbesartan was co-administered with warfarin (a drug metabolised by CYP2C9).
Irbesartan does not affect the pharmacokinetics of digoxin. The pharmacokinetics of irbesartan is not affected by co-administration with nifedipine or hydrochlorothiazide.

Potassium-sparing diuretics, potassium supplements, potassium containing salt substitutes.

Based on experience with the use of other drugs that affect the renin-angiotensin system, concomitant use of potassium-sparing diuretics, potassium supplements, salt substitutes containing potassium or other medicinal products that may increase kalaemia with irbesartan may lead to increases in serum potassium, sometimes severe, and requires close monitoring of serum potassium.

Lithium.

Increases in serum lithium concentrations and lithium toxicity have been reported with concomitant use of irbesartan. Monitor lithium levels in patients receiving irbesartan and lithium.

Combination use of ACE inhibitors or angiotensin receptor antagonists, anti-inflammatory drugs and thiazide diuretics.

Concomitant use of a renin-angiotensin system inhibiting drug (ACE-inhibitor or angiotensin receptor antagonist), and an anti-inflammatory drug (NSAID, including COX-2 inhibitor) alone or with a thiazide diuretic may increase the risk of renal impairment, including possible acute renal failure. These effects are usually reversible. This includes use in fixed-combination products containing more than one class of drug. The combination of these agents should be administered with caution, especially in the elderly, volume depleted and in patients with pre-existing renal impairment. Renal function (serum creatinine) should be monitored after initiation of concomitant therapy, and periodically thereafter. The antihypertensive effect of angiotensin II receptor antagonists, including irbesartan, may be attenuated by NSAIDs including selective COX-2 inhibitors.
The use of Karvea in combination with an ACE inhibitor is contraindicated in patients with diabetic nephropathy and is not recommended in other patients (see Section 4.3 Contraindications; Section 4.4 Special Warnings and Precautions for Use).

Renin inhibitor.

The combination of Karvea with aliskiren-containing medicinal products is contraindicated in patients with diabetes mellitus or moderate to severe renal impairment and is not recommended in other patients (see Section 4.3 Contraindications).

Angiotensin-converting enzyme inhibitors (ACE inhibitors).

The combination of Karvea with ACE inhibitors is not recommended.

Repaglinide.

Irbesartan has the potential to inhibit OATP1B1. In a clinical study, it was reported that irbesartan increased the Cmax and AUC of repaglinide (substrate of OATP1B1) by 1.8-fold and 1.3-fold, respectively, when administered 1 hour before repaglinide. In another study, no relevant pharmacokinetic interaction was reported when the two drugs were co-administered. Therefore, dose adjustment of antidiabetic treatment such as repaglinide may be required (see Section 4.4 Special Warnings and Precautions for Use).

4.6 Fertility, Pregnancy and Lactation

Effects on fertility.

Fertility and reproductive performance were not affected in studies of male and female rats at oral doses of up to 650 mg/kg/day (approximately 3 (male) and 8 (female) fold higher exposure, based on AUC, than that of humans at the maximum recommended clinical dose of 300 mg/day).
(Category D)
Drugs that act directly on the renin-angiotensin system can cause foetal and neonatal morbidity and death when administered to pregnant women. Several dozen cases have been reported in the world literature in patients who were taking angiotensin-converting enzyme inhibitors. When pregnancy is detected, Karvea should be discontinued as soon as possible.
The use of drugs that act directly on the renin-angiotensin system during the second and third trimesters of pregnancy have been associated with foetal and neonatal injury, including hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death. Oligohydramnios has also been reported, presumably resulting from decreased foetal renal function; oligohydramnios in this setting has been associated with foetal limb contractures, craniofacial deformation and hypoplastic lung development. Prematurity, intrauterine growth retardation and patent ductus arteriosus have also been reported, although it is not clear whether these occurrences were due to exposure to the drug.
These adverse effects do not appear to have resulted from intrauterine drug exposure that has been limited to the first trimester. Mothers whose embryos and foetuses are exposed to an angiotensin II receptor antagonist only during the first trimester should be so informed. Nonetheless, when patients become pregnant, physicians should have the patient discontinue the use of Karvea as soon as possible.
Infants with histories of in utero exposure to an angiotensin II receptor antagonist should be closely observed for hypotension, oliguria and hyperkalaemia.
When pregnant rats were treated with irbesartan from day 0 to day 20 of gestation, at doses of 50 mg/kg/day and higher, transient effects (increased renal pelvic cavitation, hypoureter or subcutaneous oedema) were noted in full term rat foetuses but not in the young animals necropsied after 6 weeks of age. In pregnant rabbits, at doses of 30 mg/kg/day, maternal mortality, abortion and early foetal resorptions were noted. No teratogenic effects were observed in the rat or rabbit.
Irbesartan is excreted in the milk of lactating rats. It is not known whether irbesartan or its metabolites are excreted in human milk. A decision should be made whether to discontinue breast feeding or to discontinue the drug, taking into account the importance of irbesartan to the therapy of the mother and the potential risk to the infant.

4.7 Effects on Ability to Drive and Use Machines

The effect of irbesartan on ability to drive and use machines has not been studied. When driving vehicles or operating machines, it should be taken into account that occasionally dizziness or weariness may occur during treatment of hypertension.

4.8 Adverse Effects (Undesirable Effects)

Hypertension.

Irbesartan has been evaluated for safety in approximately 5000 subjects in clinical studies, including 1300 hypertensive patients treated for over 6 months and over 400 patients treated for one year or more. Adverse events in patients receiving irbesartan were generally mild and transient with no relationship to dose. The incidence of adverse events was not related to age, gender, or race.
In placebo-controlled clinical studies, including 1965 irbesartan-treated patients (usual duration of treatment 1 to 3 months), discontinuations due to any clinical or laboratory adverse event were 3.3 percent for irbesartan-treated patients and 4.5 percent for placebo-treated patients (p = 0.029).
Clinical adverse events, occurring in at least 1% of patients treated with irbesartan in placebo controlled trials are shown in Table 1. The incidence of the same adverse events in the placebo control group is also shown.
Adverse reactions that occurred in 2 or more hypertensive patients in clinical trials involving 3396 patients have been classified using standard terminology and in the following listing are categorised by body system and listed in order of decreasing frequency according to the following definitions: common adverse reactions are those occurring on one or more occasions in at least 1/100 but less than 1/10 patients; uncommon adverse reactions are those occurring in at least 1/1000 but less than 1/100 patients; rare adverse reactions are those occurring in less than 1/1000 patients.

Cardiovascular.

Uncommon: subjective rhythm disturbance, flushing, ECG abnormality, cardiac murmur, cardiac rhythm disturbance, orthostatic hypotension, atrial rhythm disturbance, bradycardia, hypotension. Rare: syncope, conduction disorder, myocardial infarction.

Dermatologic.

Uncommon: pruritus, facial erythema. Rare: dermatitis, acne, scalp-hair abnormality.

Endocrine/metabolic/electrolyte imbalance.

Uncommon: sexual dysfunction, libido change. Rare: breast disorder, gout, hot flashes.

Gastrointestinal.

Uncommon: constipation, flatulence, dry mouth, abdomen distention. Rare: abnormal stool, decreased appetite, increased appetite, oral lesion, dysphagia, oesophagitis.

General.

Uncommon: weakness, hyperhidrosis, malaise, weight gain. Rare: cold sensation, warmth sensation, pain.

Haematopoietic.

Rare: anaemia.

Immunology/sensitivity disorder.

Uncommon: upper extremity oedema. Rare: head/neck oedema.

Musculoskeletal/connective tissue.

Uncommon: muscle cramp, swelling extremity. Rare: arthritis, muscle ache, myalgia, extremity weakness, stiffness lower extremity.

Nervous system.

Uncommon: orthostatic dizziness, numbness, sleep disturbance, depression, emotion labile/disturbance, somnolence, vertigo, paraesthesia. Rare: stress related disorder, tremor, coordination disturbance, disturbing dreams.

Renal/genitourinary.

Uncommon: urination abnormality.

Respiratory.

Uncommon: epistaxis, dyspnoea.

Special senses.

Uncommon: vision disturbance, hearing abnormality. Rare: eye disturbance (other), eyelid abnormality, visual field abnormality, medication bad taste, taste disturbance.

Hypertension and type II diabetic renal disease.

In clinical studies (see Section 5.1 Pharmacodynamic Properties, Clinical trials, Hypertension and type II diabetic renal disease), the adverse experiences were similar to those in clinical trials of hypertensive patients with the exception of orthostatic symptoms (dizziness, orthostatic dizziness and orthostatic hypotension) observed in IDNT (proteinuria ≥ 900 mg/day, and serum creatinine from 90 - 265 micromol/L). In IDNT orthostatic symptoms occurred more frequently in the Karvea group (dizziness 10.2%, orthostatic dizziness 5.4%, orthostatic hypotension 5.4%) than in the placebo group (dizziness 6.0%, orthostatic dizziness 2.7%, orthostatic hypotension 3.2%). The rates (percents) of discontinuations due to orthostatic symptoms for Karvea versus placebo were: dizziness 0.3 vs 0.5; orthostatic dizziness 0.2 vs 0.0; and orthostatic hypotension 0.0 vs 0.0.

Post-marketing experience.

As with other angiotensin-II receptor antagonists, hypersensitivity reactions (urticaria, angioedema, anaphylactic reactions including anaphylactic shock) have been reported since the marketing of irbesartan. The following have been reported during post-marketing surveillance: vertigo, asthenia, hyperkalaemia, thrombocytopenia (including thrombocytopenic purpura), myalgia, jaundice, elevated liver function tests, hepatitis, arthralgia, tinnitus, anaemia, psoriasis (and psoriasis exacerbation) (see Section 4.4 Special Warnings and Precautions for Use), photosensitivity, impaired renal function including cases of renal failure in patients at risk, and hypoglycaemia (see Section 4.4 Special Warnings and Precautions for Use).
Rare cases of rhabdomyolysis have been reported in patients receiving angiotensin II receptor blockers.

Reporting suspected adverse reactions.

Reporting of suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions at http://www.tga.gov.au/reporting-problems.

4.9 Overdose

Experience in adults exposed to doses of up to 900 mg/day for 8 weeks revealed no toxicity. No specific information is available on the treatment of overdosage with irbesartan. The patient should be closely monitored, and the treatment should be symptomatic and supportive. If simple supine positioning is found insufficient to correct hypotension then judicious I.V. volume replacement/augmentation may be indicated. Irbesartan is not removed from the body by haemodialysis.
For information on the management of overdose, contact the Poisons Information Centre on 131126 (Australia).

5 Pharmacological Properties

5.1 Pharmacodynamic Properties

Pharmacotherapeutic group: angiotensin II antagonist, plain, ATC code: C09CA04.

Mechanism of action.

Irbesartan is a specific antagonist of angiotensin II receptors (AT1 subtype). Angiotensin II is an important component of the renin-angiotensin system and is involved in the pathophysiology of hypertension and in sodium homeostasis. Irbesartan does not require metabolic activation for its activity.
Irbesartan blocks the potent vasoconstrictor and aldosterone-secreting effects of angiotensin II by selective antagonism of the angiotensin II (AT1 subtype) receptors localized on vascular smooth muscle cells and in the adrenal cortex. It has no agonist activity at the AT1 receptor and a much greater affinity (more than 8500-fold) for the AT1 receptor than for the AT2 receptor (a receptor that has not been shown to be associated with cardiovascular homeostasis).
Irbesartan does not inhibit enzymes involved in the renin-angiotensin system (i.e. renin, angiotensin converting enzyme [ACE]) or affect other hormone receptors or ion channels involved in the cardiovascular regulation of blood pressure and sodium homeostasis.
In healthy subjects, single oral irbesartan doses of up to 300 mg produced dose-dependent inhibition of the pressor effect of angiotensin II infusions. Inhibition was complete (≥ 90%) at the time of peak irbesartan concentrations and sustained for 24 hours (60% and 40% at 300 mg and 150 mg, respectively).
In hypertensive patients, angiotensin II receptor inhibition following chronic administration of irbesartan causes a 1.5-2 fold rise in angiotensin II plasma concentration and a 2-3 fold increase in plasma renin levels. Aldosterone plasma concentrations generally decline following irbesartan administration, however serum potassium levels are not significantly affected at recommended doses.
In hypertensive patients, chronic oral doses of irbesartan (up to 300 mg) had no effect on glomerular filtration rate, renal plasma/blood flow or filtration fraction. In multiple dose studies in hypertensive patients, there were no notable effects on fasting triglycerides, or total cholesterol or HDL-cholesterol. There was no effect on serum uric acid during chronic oral administration. Following repeated doses of irbesartan, there was no uricosuric effect.

Clinical trials.

The antihypertensive effects of irbesartan were examined in seven (7) major placebo-controlled 8-12 week trials in patients with baseline diastolic blood pressures of 95-110 mmHg.
The seven (7) studies of irbesartan monotherapy included a total of 1915 patients randomised to irbesartan (1-900 mg) and 611 patients randomised to placebo. Once daily doses of 150 to 900 mg provided statistically and clinically significant decreases in systolic and diastolic blood pressure with a plateau in effect at doses above 300 mg.
Systolic/diastolic mean decreases in blood pressure at trough (24 hours postdosing), compared to placebo, following 6 to 12 weeks of treatment were in the range of 7.5-9.9/4.6-6.2 mmHg with a 150 mg dose, and 7.9-12.6/5.2-7.9 mmHg with a 300 mg dose.
Once-daily dosing with 150 mg gave trough and mean 24 hour responses corresponding to those observed in patients receiving twice-daily dosing at the same total daily dose. Peak (3-6 hour) effects were uniformly, but moderately, larger than trough effects, with the trough to peak ratio for systolic and diastolic response generally between 60-70%.
Two of the seven placebo-controlled trials identified above and two additional studies examined the antihypertensive effects of irbesartan and hydrochlorothiazide in combination.
Addition of a low dose of hydrochlorothiazide (12.5 mg) to irbesartan (75 to 300 mg) once daily resulted in further diastolic blood pressure reductions at trough (24 hours post-dosing) of 2.3-4.8 mmHg and an overall systolic/diastolic placebo-subtracted reduction of up to 13.6/11.5 mmHg at a dose of 300 mg irbesartan and 12.5 mg hydrochlorothiazide. Once daily dosing with 150 mg irbesartan and 12.5 mg hydrochlorothiazide gave systolic/diastolic mean placebo-adjusted blood pressure reductions at trough (24 hours post-dosing) of 12.9/6.9 mmHg.
In patients not adequately controlled (SeDBP ≥ 90 mmHg) on irbesartan (up to 300 mg) alone, the addition of 12.5 mg hydrochlorothiazide gave an added reduction of up to 6.1 mmHg in trough (24 hours) diastolic blood pressure.
In patients not adequately controlled (SeDBP 93-120 mmHg) on 25 mg hydrochlorothiazide alone, the addition of irbesartan (75-150 mg) gave an added systolic/diastolic mean reduction of 11.1/7.2 mmHg.
Analysis of age, gender and race subgroups of patients showed that men and women, and patients over and under 65 years of age, had generally similar responses.
The effect of irbesartan is apparent after the first dose, substantially present within 1-2 weeks, and reaches a maximal effect within 4-6 weeks. In long-term studies the effect of irbesartan appeared to be maintained for more than one year. After withdrawal of irbesartan, blood pressure gradually returned towards baseline; no rebound was observed. There was essentially no change in average heart rate in irbesartan-treated patients in controlled trials.

Hypertension and type II diabetic renal disease.

The Irbesartan Diabetic Nephropathy Trial (IDNT) was a multicentre, randomised, controlled, double-blind, morbidity and mortality trial comparing Karvea, amlodipine and placebo. In 1715 hypertensive patients with type II diabetes (proteinuria ≥ 900 mg/day and serum creatinine 110-265 micromol/L in men and 90-265 micromol/L in women) the long-term effects (mean 2.6 years) of Karvea on the progression of renal disease and all-cause mortality were examined. In addition, a secondary end-point, the effect of Karvea on the risk of fatal or non-fatal cardiovascular events was assessed. Patients were randomised to receive Karvea 75 mg, amlodipine 2.5 mg, or matching placebo once-daily. Patients were then titrated to a maintenance dose of 300 mg Karvea, 10 mg amlodipine, or placebo as tolerated. Additional antihypertensive agents (excluding ACE inhibitors, angiotensin II receptor antagonists and calcium channel blockers) were added as needed to help achieve blood pressure goal (≤ 135/85 or 10 mmHg reduction in systolic blood pressure if higher than 160 mmHg) for patients in all groups. Karvea demonstrated a 20% relative risk reduction in the composite primary endpoint (first occurrence of any of the following: doubling of serum creatinine, end-stage renal disease or all-cause mortality) compared to placebo (95% CI (3%, 34%), p = 0.023) and a 23% relative risk reduction compared to amlodipine (95% CI (7%, 37%), p = 0.006). When the individual components of the primary endpoint were analysed, no effect in all cause mortality was observed, while a positive trend in the reduction in ESRD and a significant reduction in doubling of serum creatinine were observed. Similar blood pressure was achieved in the Karvea and amlodipine groups. There was no significant difference in the assessment of fatal or non-fatal cardiovascular events (cardiovascular death, non-fatal myocardial infarction, hospitalisation for heart failure, permanent neurologic deficit attributed to stroke, or above-the-ankle amputation) among the three treatment groups.
The study of the Effects of Irbesartan on MicroAlbuminuria in Hypertensive Patients with Type II Diabetes Mellitus (IRMA 2) was a multicentre, randomised, placebo-controlled, double-blind morbidity study, conducted in 590 hypertensive patients with type II diabetes, micro-albuminuria (20 - 200 microgram/min; 30 - 300 mg/day) and normal renal function (serum creatinine ≤ 130 micromol/L in males and ≤ 100 micromol/L in females). The study examined as a primary endpoint the long-term effects (2 years) of Karvea on the progression to (overt) proteinuria (urinary albumin excretion rate [AER] > 200 microgram/min [> approximately 300 mg/day] and an increase in AER of at least 30% from baseline). In addition, after one and two years of treatment, the effect of Karvea on the change in overnight AER and the change in 24-hour creatinine clearance was assessed. Patients were randomised to receive Karvea 150 mg, Karvea 300 mg, or matching placebo once daily.
Additional antihypertensive agents (excluding ACE inhibitors, angiotensin II receptor antagonists and dihydropyridine calcium blockers) were added as needed to help achieve blood pressure goal (≤ 135/85 mmHg) for patients in all groups. Karvea 300 mg demonstrated a 70% relative risk reduction in the development of clinical (overt) proteinuria compared to placebo (95% CI (39%, 86%), p = 0.0004). Karvea 150 mg demonstrated a 39% relative risk reduction in the development of proteinuria compared to placebo (95% CI (-8%, 66%), p = 0.085). In the intent to treat analysis, when the primary endpoint is adjusted for urinary albumin excretion rate and mean arterial pressure, Karvea 300 mg demonstrated a 68% relative risk reduction, (95% CI (35%, 85%), p = 0.002). The slowing of progression to clinical (overt) proteinuria was evident as early as three months and continued over the 2 year period. The decline in 24-hour creatinine clearance did not differ significantly among the 3 groups. Regression to normoalbuminuria (< 20 microgram/min; < 30 mg/day) was more frequent in the Karvea 300 mg group (34%) than in the placebo group (21%).
The adverse experiences reported in these two studies are summarised (see Section 4.8 Adverse Effects (Undesirable Effects), Hypertension and type II diabetic renal disease; Section 4.4 Special Warnings and Precautions for Use, Effects on laboratory tests.

5.2 Pharmacokinetic Properties

Irbesartan is an orally active agent and does not require biotransformation for its activity.

Absorption.

Following oral administration, irbesartan is rapidly and well absorbed. In studies employing an injection and an oral solution containing radio-labelled irbesartan the average absolute oral bioavailability of irbesartan was 60-80%. Median peak plasma concentrations generally occurred 1.5-2 hours after oral administration of irbesartan capsules and tablets. Food did not affect the bioavailability.

Distribution.

Irbesartan is 90% protein-bound in the plasma, and has negligible binding to cellular components of blood. The volume of distribution (Vss) is 53-93 L.

Metabolism.

Following oral or intravenous administration of 14C-irbesartan more than 80% of the circulating plasma radioactivity was attributable to unchanged irbesartan. Irbesartan is metabolised by the liver via glucuronide conjugation and oxidation. The major circulating metabolite is irbesartan glucuronide (~ 6%). Irbesartan undergoes oxidation primarily by the cytochrome P450 isoenzyme CYP2C9; isoenzyme CYP3A4 has negligible effect. It is not metabolised by, nor does it substantially induce or inhibit, most isoenzymes commonly associated with drug metabolism (i.e. CYP1A1, CYP1A2, CYP2A6, CYP2B6, CYP2D6, or CYP2E1). Irbesartan does not induce nor inhibit isoenzyme CYP3A4.

Excretion.

Irbesartan and its metabolites are excreted by both biliary and renal routes. About 20% of the administered radioactivity after an oral or intravenous dose of 14C-irbesartan was recovered in urine with the remainder in the faeces. Less than 2% of the dose was excreted in urine as unchanged irbesartan.
The terminal elimination half-life (t½) of irbesartan averaged 11 - 15 hours over a range of doses following multiple oral dosing. The total body clearance of intravenously administered irbesartan was 157-176 mL/min, of which 3.0-3.5 mL/min was renal clearance. Irbesartan exhibits linear pharmacokinetics over the therapeutic dose range. Steady-state plasma concentrations are attained within 3 days after initiation of a once-daily dosing regimen. Limited accumulation (< 20%) is observed in plasma upon repeated once-daily dosing.

Special populations.

In male and female hypertensive subjects, higher (11-44%) plasma concentrations of irbesartan were observed in females than in males, although, following multiple dosing, males and females did not show differences in either accumulation or elimination half-life. No gender-specific differences in clinical effect have been observed.
In elderly (male and female) normotensive subjects (65-80 years) with clinically normal renal and hepatic function, the plasma AUC and peak plasma concentrations (Cmax) of irbesartan are approximately 20%-50% greater than those observed in younger subjects (18-40 years). Regardless of age, the elimination half-life is comparable. No significant age-related differences in clinical effect have been observed.
In black and white normotensive subjects, the plasma AUC and t½ of irbesartan are approximately 20-25% greater in blacks than in whites; the peak plasma concentrations (Cmax) of irbesartan are essentially equivalent.
In patients with renal impairment (regardless of degree) and in haemodialysis patients, the pharmacokinetics of irbesartan are not significantly altered. Irbesartan is not removed by haemodialysis.
In patients with hepatic insufficiency due to mild to moderate cirrhosis, the pharmacokinetics of irbesartan are not significantly altered.

5.3 Preclinical Safety Data

Genotoxicity.

Irbesartan was not genotoxic in a series of assays for mutagenic and clastogenic effects.

Carcinogenicity.

The carcinogenic potential of irbesartan was assessed in two 104 week studies in mice and rats. No carcinogenic potential was observed in either species at doses of up to 500 mg/kg/day (male rats) and 1000 mg/kg/day (mice and female rats). The AUC based exposure levels were 3 - 6 fold higher in mice, 3-fold higher in male rats and 25-fold higher in female rats than that of humans at the maximum recommended clinical dose of 300 mg/day.

6 Pharmaceutical Particulars

6.1 List of Excipients

The inactive ingredients are: carnauba wax, croscarmellose sodium, hypromellose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, silicon dioxide, and Opadry II complete film coating system 32F38977 White.

6.2 Incompatibilities

Incompatibilities were either not accessed or not identified as part of the registration of this medicine.

6.3 Shelf Life

In Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

Store below 25°C.

6.5 Nature and Contents of Container

Pack sizes include: 3*, 5*, 7**, 14*, 28*, 30, 56* and 98* tablets in polyvinyl chloride/polyvinylidene chloride/aluminium (PVC/PVDC/Al) blisters.
* Presentations currently not-marketed.
** Starter pack.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of by taking to your local pharmacy.

6.7 Physicochemical Properties

Irbesartan is a white to practically white powder that is less than 0.1 mg/mL soluble in water and slightly soluble in alcohol and methylene chloride.
Irbesartan is 2-butyl-3-[(2'-(1H-tetrazol-5-yl) biphenyl-4-yl)methyl]- 1,3-diazaspiro [4,4] non-1-en-4-one.

Chemical structure.

The chemical structure of irbesartan is:
The empiric formula is C25H28N6O and the molecular weight, 428.5.

CAS number.

138402-11-6.

7 Medicine Schedule (Poisons Standard)

Schedule 4.

Summary Table of Changes