Description

Azilsartan medoxomil is an angiotensin II receptor blocker (ARB). Azilsartan helps blood vessels to dilate. It also helps to excrete of Sodium and water from body. This combination also contains a diuretic. Chlorthalidone works in the kidneys to flush excess water and salt (sodium) from the body. Together, these 2 medicines work to help lower blood pressure in people who need more than 1 medicine to treat their high blood pressure (hypertension). Absorption: Azilsartan medoxomil is rapidly hydrolyzed to azilsartan, the active metabolite, in the gastrointestinal tract during absorption. Azilsartan medoxomil is not detected in plasma after oral administration. The estimated absolute bioavailability of azilsartan following administration of azilsartan medoxomil is approximately 60%. After oral administration of azilsartan medoxomil, peak plasma concentrations (Cmax) of azilsartan are reached within 1.5 to 3 hours. Food does not affect the bioavailability of azilsartan. Distribution: The volume of distribution of azilsartan is approximately 16L. Azilsartan is highly bound to human plasma proteins (>99%), mainly serum albumin. Protein binding is constant at azilsartan plasma concentrations well above the range achieved with recommended doses. In whole blood, chlorthalidone is predominantly bound to erythrocyte carbonic anhydrase. In the plasma, approximately 75% of chlorthalidone is bound to plasma proteins, 58% of the drug being bound to albumin. Metabolism and Elimination: Azilsartan medoxomil: Azilsartan is metabolized to two primary metabolites. The major metabolite in plasma is formed by O-dealkylation, referred to as metabolite M II, and the minor metabolite is formed by decarboxylation, referred to as metabolite M-I. Systemic exposures to the major and minor metabolites in humans were approximately 50% and less than 1% of azilsartan, respectively. M-I and MII do not contribute to the pharmacologic activity of azilsartan medoxomil. The major enzyme responsible for azilsartan metabolism is CYP2C9. The elimination half-life of azilsartan is approximately 11 hours and renal clearance is approximately 2.3 mL/min. Steady-state levels of azilsartan are achieved within 5 days and no accumulation in plasma occurs with repeated once-daily dosing. Chlorthalidone: The major portion of the drug is excreted unchanged by the kidneys. Nonrenal routes of elimination have yet to be clarified. Data are not available regarding the percentage of dose as unchanged drug and metabolites, the concentration of the drug in body fuids, degree of uptake by a particular organ or in the fetus, or passage across the blood-brain barrier.

This is contraindicated in patients with anuria.

The following potential adverse reactions are- Fetal toxicity Hypotension in Volume- or Salt-Depleted Patients Impaired Renal Function Hypokalemia Hyperuricemia

Pregnancy Category D. Use of drugs that affect the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death.

In patients with an activated renin-angiotensin-aldosterone system (RAAS), such as volume- and/or salt-depleted patients, this combination can cause excessive hypotension. Correct volume or salt depletion prior to administration of azilsartan and chlorthalidone. In patients with renal artery stenosis, This combination may cause renal failure. Monitor renal function in patients with renal impairment. Consider discontinuing this combination with progressive renal impairment. Heart rhythm problems (e.g., bradycardia, QT prolongation, ventricular tachycardia), liver problems, certain uncorrected mineral imbalances (low potassium/magnesium levels), severe kidney problems.

Combined antihypertensive preparations

Store in a cool & dry place, away from light and children.