Irbis Special Precautions

Intravascular volume depletion: Symptomatic hypotension especially after the first dose may occur in patients who are volume and/or sodium depleted by vigorous diuretic therapy, dietary salt restriction and diarrhea or vomiting. Such conditions should be corrected before the administration of Irbesartan.
Renovascular hypertension: There is an increased risk of severe hypotension and renal insufficiency when patients with bilateral renal artery stenosis of the artery to a single functioning kidney are treated with drugs that affect the renin angiotensin-aldosterone system.
Renal impairment and kidney transplantation: When Irbesartan is used in patients with impaired renal function, a periodic monitoring of potassium and creatinine serum levels is recommended. There is no experience regarding the administration of Irbesartan in patients with recent kidney transplantation.
Hypertensive patients with type 2 diabetes and renal diseases: The effects of Irbesartan both on renal and cardiovascular events were not uniform across all subgroups, in an analysis carried out in the study with patients with advanced renal disease. In particular, they appeared less favorable in women and non-white subjects (see Pharmacology: Pharmacodynamics under Actions).
Hyperkalemia: As with other drugs that affect the renin-angiotensin aldosterone system, hyperkalemia may occur during the treatment with Irbesartan, especially in the presence of renal impairment, overt proteinuria due to diabetic renal disease, and/or heart failure.
Close monitoring of serum potassium in patients at risk is recommended (see Interactions).
Lithium: The combination of lithium and Irbesartan is not recommended (see Interactions).
Aortic and mitral valve stenosis, obstructive hypertrophic cardiomyopathy: As with other vasodilators, special caution is indicated in patients suffering from aortic or mitral stenosis, or obstructive hypertrophic cardiomyopathy.
Primary aldosteronism: Patients with primary aldosteronism generally will not response to antihypertensive drugs acting through inhibition of the renin-angiotensin system. Therefore, the use of Irbesartan is not recommended.