Eprosartan (Teveten) is an angiotensin-converting-enzyme inhibitor that is used as monotherapy or in combination with other antihypertensive medications to reduce the blood pressure in hypertensive patients.

Eprosartan Uses:

• Hypertension:

  • It is used for treating hypertension

• Off Label Use of Eprosartan in Adults:

  • Acute coronary syndrome for secondary prevention
  • Stable coronary artery disease

Eprosartan (Teveten) Dose in Adults

Eprosartan (Teveten) Dose in the treatment of Hypertension:

Note: For initial treatment:

• • ≥20/10 mm Hg above goal, may be used in conjunction with other medicines in combination treatment (eg, a long-acting dihydropyridine calcium channel blocker or thiazide diuretic).
  • <20/10 mm Hg above the target, however many people eventually require combo medications.
• Oral:
  • Initial: 600 mg once a day
  • Every 4 to 6 weeks, assess response and modify dosage.
  • One or two divided dosages of up to 800 mg/day may be administered.

Dose in Children:

Not indicated.

Pregnancy Risk Factor D

• [Warning for US Boxes] Drugs that interfere with the renin-angiotensin system can damage or even kill a developing foetus.
• It's crucial to stop taking the medication as soon as you find out you're pregnant.
• Drugs that affect the RAAS system have the potential to cause oligohydramnios, which can result in skeletal or foetal lung abnormalities or hypoplasia.
• Exchange transfusions may be required for infants who are exposed in utero. The second and third trimesters are when most complications occur in neonates.
• Monitoring the exposed fetus for growth, amniotic fluid volume and formation of organs is important.
• These complications are caused by maternal use during the second and third trimesters.

Eprosartan use during breastfeeding:

• It is unknown if breast milk contains eprosartan.
• The benefits of valsartan for the mother and the benefits of breastfeeding the infant should be considered by the clinician.

Eprosartan (Teveten) Dose in Kidney disease:

• Mild impairment:

  • No dose adjustment required.

• Moderate to severe impairment:

  • The manufacturer has not recommended any dosage adjustment in severe renal disease
  • maximum dose: 600 mg daily.

• Hemodialysis:

  • The manufacturer has not recommended any dosage adjustment in severe renal disease; eprosartan is poorly removed by hemodialysis (Cl <1 L/hour)

Dose in Liver disease:

No dosage adjustment required.

Less Common Side Effects of Eprosartan (Teveten):

• Cardiovascular:

  • Chest Pain

• Central Nervous System:

  • Fatigue
  • Dizziness
  • Headache
  • Depression

• Endocrine & Metabolic:

  • Dependent Edema
  • Hypertriglyceridemia

• Gastrointestinal:

  • Abdominal Pain
  • Diarrhea
  • Dyspepsia

• Genitourinary:

  • Urinary Tract Infection

• Infection:

  • Viral Infection

• Neuromuscular & Skeletal:

  • Arthralgia
  • Myalgia

• Renal:

  • Increased Blood Urea Nitrogen

• Respiratory:

  • Upper Respiratory Tract Infection
  • Pharyngitis
  • Rhinitis
  • Cough
  • Bronchitis
  • Sinusitis

• Miscellaneous:

  • Accidental Injury

Contraindications to Eprosartan (Teveten):

• Hypersensitivity
• Use of a direct renin inhibitor in conjunction

Because of the similarities in structure/function, it is impossible to rule out the possibility of cross-sensitivity between angiotensin receptor blockers and angiotensin 2, but this cannot be excluded.

Canadian labeling: Additional contraindications not in US labeling

• Renovascular disease on both sides, or severe stenosis in one functioning kidney
• Galactose intolerance or glucose-galactose malabsorption, also known as Lapp lactase deficiencies, or Galactose intolerance
• Combination use of aliskiren for severe renal impairment (GFR 60mL/minute/1.73m2)
• Combination with ACEi for patients with diabetic nephropathy
• Pregnancy
• Breastfeeding

Warnings and precautions

• Angioedema

  • Angioedema can occur (rarely) during any treatment.
  • Patients who have angioedema that is associated with ACE inhibitors, idiopathic or hereditary may be at greater risk.
  • It is possible to have abdominal pain due to involvement of the head, neck, or intestine.
  • If patients experience swelling in the larynx, glottis or face, it is important to monitor them.
  • If angioedema develops, stop taking medication immediately. Do not restart therapy for future uses
  • It is important to treat the patient immediately and aggressively. Intramuscular (IM), administration of epinephrine might be necessary.

• Hyperkalemia:

  • Hyperkalemia is a more common risk. Risk factors include:
    • Renal dysfunction
    • DM
    • Concomitant use ACEi, aliskiren and potassium-sparing uriters
    • Potassium supplementation, potassium-containing Salts

• Hypotension

  • Hypotension is a risk factor for patients who are salt- and volume-depleted (e.g. Patients taking high-dose diuretics. The patient must be well hydrated before initiating treatment.

• Renal function deterioration:

  • Patients with decreased renal blood flow, such as Patients with renal artery stenosis and heart disease may experience acute renal impairment.
  • Small increases in serum creatinine may occur once treatment begins; however, stopping treatment will cause a severe or gradual decline in renal function.

• Aortic/mitral stenosis:

  • Patients with severe aortic/mitralstenosis should be cautious.

• Ascites:

  • Patients with cirrhosis should not use it as there is a risk of rapid decline in renal function.

• Renal artery stenosis

  • It should not be used by individuals who have unilateral or bilateral renal arterial stenosis.
  • High risk of renal dysfunction deterioration

• Renal impairment

  • Prevent severe renal impairment and renal insufficiency.

Eprosartan: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

• Blood pressure
• serum potassium
• serum creatinine
• BUN
• eGFR 

Hypertension: The 2017 guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.

• Less than 130/80 mmHg in hypertensive patients with known cardiovascular disease or a 10-year ASCVD risk of more than 10%.
• Less than 130/80 mmHg may be reasonable in hypertensive patients without markers of ASCVD risk.

Blood pressure targets in Diabetic patients: (ADA 2019):

• Less than 140/90 in patients with co-morbid diabetes and hypertension and age less than 65 years

• Less than 130/80 among diabetic patients under 65 who are also at high risk for cardiovascular disease.

• Less than 140/90 mmHg in diabetic patients above the age of 65.

• Less than 150/90 mmHg in patients with diabetes and a poor health status who are older than 65.

How to administer Eprosartan (Teveten)?

Oral: May be taken with or without food.

Mechanism of action of Eprosartan (Teveten):

• Eprosartan is an inhibitor of angiotensin II. 
• It preferentially prevents angiotensin II from binding to the AT1 receptor.

The following mechanisms can be used to lower blood pressure:

• Vasodilation
• Inhibition of aldosterone production
• Catecholamine inhibition
• Blocking the release arginine vasopressin
• Hypertrophic and water intake can be inhibited.

ACEi blocks the biosynthesis angiotensin II (angiotensin 1) and causes bradykinin to be degraded. Eprosartan is not an inhibitor of ACE and does not alter the bradykinin response. It also has fewer side effect than ACEi.

Protein binding:

• 98%

Metabolism:

• Minimally hepatic

Bioavailability:

• 300 mg dose: 13%

Half-life elimination:

• Terminal: 5 - 9 hours

Time to peak, serum:

• Fasting: 1 - 2 hours

Excretion: mainly through feces

• Feces (90%)
• Urine (7%, mostly as unchanged drug)

International Brand Names of Eprosartan:

• Teveten
• Cosarnomid
• Epratenz
• Futuran
• Tangio
• Tensrelive
• Teveten
• Tevetens
• Tevetenz

Eprosartan Brand Names in Pakistan: