| Drug | Key Clinical Use / Notes | Dosing (Adult) | Renal Dose Adjustment | Monitoring | Clinical Tips (Pharmacy-Centered) |
|---|---|---|---|---|---|
| Losartan | • First-line HTN • Great in diabetic nephropathy • Preferred ARB for gout (↓ uric acid) |
HTN: 50 mg daily → up to 100 mg/day Nephropathy: start 50 mg daily |
No dose adjustment; caution CrCl < 30 mL/min | BP, serum K⁺, SCr, uric acid | • Best option in patients with gout or hyperuricemia • Consider BID dosing if BP not controlled • Use ACEi or thiazide combination for synergy |
| Valsartan | • Strong HF evidence (post-MI, HFrEF) • Great alternative if ACEi cough/angioedema |
HTN: 80–160 mg daily (max 320 mg) HF: 40 mg BID → 160 mg BID |
No dose adjustment; but ↓ starting dose in severe renal impairment | BP, HR, K⁺, SCr, HF symptoms | • In HF, start low to avoid hypotension • Avoid dual RAAS inhibition with ACEi/renin inhibitor • Watch for ↑ potassium especially with spironolactone |
| Olmesartan | • Strong BP lowering effect • Associated rare GI enteropathy |
20 mg daily → 40 mg max | No dose adjustment | BP, bowel symptoms, serum K⁺ | • Chronic diarrhea + weight loss → think olmesartan-induced enteropathy • Avoid if history of celiac-like syndromes |
| Irbesartan | • Preferred in diabetic nephropathy • Good once-daily control |
150 mg daily → up to 300 mg/day | No adjustments, but caution ESRD | K⁺, renal function, A1C, proteinuria | • Better proteinuria reduction vs losartan • Great add-on when ACEi intolerant for CKD pts |
| Telmisartan | • Longest half-life (24 hr) → great adherence • PPAR-γ effects → modest metabolic benefit |
40 mg daily → 80 mg/day | Avoid in severe hepatic impairment (biliary clearance) | BP, K⁺, renal Liver function if hepatic disease |
• Best for once-daily long-lasting BP control • Useful in metabolic syndrome, diabetes • Avoid in severe liver disease |
| Candesartan | • Strong HF mortality data (HFrEF) • Good BP potency |
HTN: 8–16 mg/day (max 32 mg) HF: 4 mg/day → 32 mg |
Adjust only if CrCl <15 mL/min | Electrolytes, renal, HF assessment | • Slow titration in HF to avoid hypotension • Often tolerated better than valsartan in sensitive patients |
| Azilsartan | • Highest comparative BP reduction among ARBs • Newer & costlier |
40–80 mg daily | No dose adjustment | BP response, renal, K⁺ | • Consider as substitute when others fail BP goals • Often requires formulary approval or prior auth |
Extra Clinical-Pearls Summary (Fast-Recall)
| Situation | Best ARB Choice |
|---|---|
| Diabetes + CKD + proteinuria | Irbesartan or Losartan |
| Gout / uric acid elevation | Losartan only |
| Heart Failure (HFrEF) / post-MI | Valsartan or Candesartan |
| Adherence issues (need long duration) | Telmisartan (24-hr half-life) |
| Severe uncontrolled HTN despite other ARBs | Azilsartan (strongest BP-lowering) |
| Chronic unexplained diarrhea | Avoid Olmesartan |