Fimasartan (Kanarb)

Indications


Pharmacology

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Metabolism

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Administration

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Dose Adjustment

  • Hepatic:
  • Renal:

Adverse Effects

Allergic/Immunologic Adverse Effects

Angioedema (see Urticaria-Angioedema, [[Urticaria-Angioedema]])

  • Epidemiology: less common with ARB’s than with ACE inhbitors
    • Telmisartan (0.1%) has a lower incidence of angioedema than ramipril (0.3%) [MEDLINE]
    • Cross-Reactivity
      • In patients with ACE-inhibitor-associated angioedema, the risk of development of any subsequent ARB-associated angioedema is 2-17%
      • In patients with ACE-inhibitor-associated angioedema, the risk of development of subsequent confirmed ARB-associated angioedema is 0-9.2%
  • Physiology: class effect (common to all ARB’s)

Cardiovascular Adverse Effects

Hypotension (see Hypotension, [[Hypotension]])

  • Epidemiology: more common with ARB’s than with ACE inhibitors
    • Telmisartan has significantly higher rate of symptomatic hypotension (2.6%) vs ramipril (1.7%) [MEDLINE]
  • Physiology: class effect (common to all ARB’s)
    • Due to basic pharmacology of ARB’s

Syncope (see Syncope, [[Syncope]])

  • Epidemiology: ramipril (0.2%) and telmisartan (0.2%) have similar rates of syncope requiring discontinuation of the drug [MEDLINE]

Endocrinologic Adverse Effects

Pulmonary Adverse Effects

Cough (see Cough, [[Cough]])

  • Epidemiology: less common with ARB’s than with ACE-Inhibitors
    • Ramipril has higher incidence of cough (4.2%) than telmisartan (1.1%) [MEDLINE]
  • Physiology: class effect (common to all ARB’s)

Renal Adverse Effects

Acute Kidney Injury (AKI) (see Acute Kidney Injury, [[Acute Kidney Injury]])

  • Epidemiology
    • Ramipril (1.9%) and telmisartan (2.0%) demonstrate similar rates of AKI, as defined by doubling of serum creatinine [MEDLINE]

Hyperkalemia (see Hyperkalemia, [[Hyperkalemia]])

  • Epidemiology: similar rates of hyperkalemia are observed with ramipril (3.3%) and telmisartan (3.4%) [MEDLINE]
  • Physiology: due to drug-induced hypoaldosteronism (see above)

Non-Anion Gap Metabolic Acidosis (see Metabolic Acidosis-Normal Anion Gap, [[Metabolic Acidosis-Normal Anion Gap]])

  • Physiology: due to drug-induced hypoaldosteronism (see above)

Other Adverse Effects

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References

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