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Adarbi 40mg — Azilsartan Medoxomil ARB for Hypertension in Diabetes

Adarbi 40mg — Azilsartan Medoxomil ARB for Hypertension in Diabetes
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Adarbi 40mg — Azilsartan Medoxomil ARB for Hypertension in Diabetes
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Adarbi 40mg Tablet — Azilsartan Medoxomil

Generic Name: Azilsartan Medoxomil 40mg

Manufacturer: Beximco Pharmaceuticals Ltd.

Drug Class: Angiotensin II Receptor Blocker (ARB) — Antihypertensive

Dosage Form: Tablet

Prescription Status: Prescription Only (Rx)

Mechanism of Action

Azilsartan medoxomil is a prodrug converted to the active form azilsartan, a selective and potent antagonist of the angiotensin II type 1 (AT1) receptor. By blocking AT1 receptors, it prevents angiotensin II-mediated vasoconstriction, aldosterone secretion, sympathetic activation, and sodium retention — leading to vasodilation and blood pressure reduction. Azilsartan has among the highest AT1 receptor binding affinity of all ARBs, resulting in more sustained 24-hour blood pressure control.

Relevance to diabetes: Hypertension is a major comorbidity in Type 2 Diabetes, significantly amplifying cardiovascular and renal risks. ARBs like azilsartan also provide reno-protective effects by reducing intraglomerular pressure and proteinuria — slowing the progression of diabetic nephropathy.

Advantages of Azilsartan

  • Superior 24-hour blood pressure reduction compared to valsartan and olmesartan in head-to-head trials
  • Once-daily dosing with consistent trough-to-peak ratio
  • Renoprotective — reduces albuminuria in diabetic nephropathy
  • No significant metabolic effects — does not worsen blood glucose, lipids, or uric acid
  • Well tolerated; no cough (unlike ACE inhibitors)

Indications

  • Hypertension (primary/essential) — monotherapy or in combination
  • Hypertension with Type 2 Diabetes — cardiovascular risk reduction
  • Diabetic nephropathy with hypertension — renoprotection and blood pressure control
  • Heart failure with reduced ejection fraction (as part of RAAS blockade)

Dosage and Administration

StageDoseNotes
Starting dose40mg once dailyWith or without food
TitrationIncrease to 80mg after 2–4 weeksIf BP target not achieved on 40mg
Maximum dose80mg once dailyHigher doses provide no added benefit
Volume-depleted patientsStart at 40mg — monitor closelyRisk of symptomatic hypotension

Take at the same time each day. May be taken with or without food. Full antihypertensive effect seen within 2 weeks; maximum effect at 4 weeks.

Blood Pressure Targets in Diabetes

Patient GroupBP TargetNotes
Diabetes + Hypertension (general)<130/80 mmHgADA/ESC 2023 guideline target
Diabetic nephropathy (proteinuria)<130/80 mmHgARB preferred; monitor K+ and creatinine
Elderly (>65 years)<140/90 mmHg (individualise)Avoid aggressive lowering; fall risk

Black Box Warning — Foetal Toxicity

Azilsartan is contraindicated in pregnancy. Drugs acting on the renin-angiotensin system can cause foetal and neonatal injury or death when administered in the 2nd and 3rd trimesters. Discontinue as soon as pregnancy is detected. Counsel women of childbearing potential about the risk.

Contraindications

  • Pregnancy (all trimesters)
  • Hypersensitivity to azilsartan or any ARB
  • Co-administration with aliskiren in patients with diabetes or moderate-to-severe renal impairment (eGFR <60)
  • Concurrent use with ACE inhibitor (dual RAAS blockade — increased risk of hypotension, hyperkalaemia, renal impairment)

Drug Interactions

Drug / ClassEffect
ACE inhibitors / AliskirenAvoid — dual RAAS blockade; hypotension, hyperkalaemia, renal failure
Potassium-sparing diuretics, potassium supplementsHyperkalaemia risk — monitor serum K+
NSAIDsAttenuate antihypertensive effect; worsen renal function
LithiumARBs reduce lithium clearance — toxicity risk
Antidiabetic agents (SU, insulin)ARBs may enhance hypoglycaemic effect — monitor blood glucose

Side Effects

SystemSide Effects
CardiovascularHypotension (especially in volume-depleted patients), dizziness
RenalRise in serum creatinine (especially in RAS-dependent renal perfusion), hyperkalaemia
GINausea, diarrhoea (uncommon)
RespiratoryNo cough (unlike ACE inhibitors)
MetabolicMild elevation in creatinine (acceptable within first 2 weeks — monitor)

Monitoring

  • Blood pressure — at each clinic visit; home monitoring encouraged
  • Serum potassium and creatinine — at baseline, 2 weeks after initiation/dose change, then annually
  • Urine albumin-to-creatinine ratio (ACR) — annually in diabetic nephropathy
  • Pregnancy test — in women of childbearing potential before starting

Storage

Store below 30°C. Protect from moisture and light. Keep out of reach of children.

Medical Disclaimer

The information provided here is for educational and informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Adarbi (Azilsartan Medoxomil) must only be used under the supervision of a qualified physician. This medication is contraindicated in pregnancy. Regular monitoring of blood pressure, renal function, and serum potassium is essential. DiabetesStore.com.bd does not endorse self-medication.

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