irbesartan/hydrochlorothiazide (Rx)

Brand and Other Names:Avalide
  • Print

Dosing & Uses


Dosage Forms & Strengths



  • 150mg/12.5mg
  • 300mg/12.5mg


150 mg/12.5 mg PO qDay initially; if needed, after 1-2 weeks may titrate up to 300 mg/25 mg PO qDay

Safety and efficacy not established



Interaction Checker

and irbesartan/hydrochlorothiazide

No Results

     activity indicator 
    No Interactions Found
    Interactions Found


      Serious - Use Alternative

        Significant - Monitor Closely


            All Interactions Sort By:
             activity indicator 

            Adverse Effects

            Adverse reactions with combination products and individual agents



            • Hyperkalemia (19%)


            Chest pain (2%)

            Tachycardia (1%)

            Abnormal urination (2%)

            Musculoskeletal pain (6%)

            Flu-like syndrome (3%)

            Edema (3%)

            Tachycardia (1%)

            Chest pain (2%)

            Creatinine increased (1%)

            Increased BUN (2%)


            • Dizziness (10%)
            • URI (9%)
            • Orthostatic hypotension (5%)
            • Fatigue (4%)
            • Diarrhea (3%)
            • Dyspepsia (2%)

            Frequency Not Defined


            • Anorexia Epigastric distress
            • Hypotension
            • Orthostatic hypotension
            • Photosensitivity
            • Anaphylaxis
            • Anemia
            • Confusion
            • Erythema multiforme
            • Stevens-Johnson syndrome
            • Exfoliative dermatitis including toxic epidermal necrolysis
            • Dizziness
            • Hypokalemia and/or hypomagnesemia
            • Hyperuricemia
            • Headache

            Postmarketing Reports




            Jaundice (with irbesartan)

            Heart failure

            Sexual dysfunction


            Impaired renal function, including renal failure (with irbesartan)

            Increased CPK levels (with ARBs)



            • Non-melanoma skin cancer
            • Acute angle-closure glaucoma, acute myopia, choroidal effusion


            Black Box Warnings

            Discontinue as soon as possible when pregnancy is detected; affects renin-angiotensin system causing oligohydramnios, which may result in fetal injury and/or death


            Hypersensitivity to irbesartan, hydrochlorothiazide, or sulfonamides

            Pregnancy (2nd and 3rd trimesters): Significant risk of fetal/neonatal morbidity and mortality


            Do not coadminister with aliskiren in patients with diabetes mellitus


            Hydrochlorothiazide, a sulfonamide, can cause an idiosyncratic reaction resulting in acute angle-closure glaucoma and elevated intraocular pressure with or without a noticeable acute myopic shift and/or choroidal effusions; cases of acute angle-closure glaucoma reported; symptoms include acute onset of decreased visual acuity or ocular pain and typically occur within hours to weeks of drug initiation; untreated acute angle-closure glaucoma may result in permanent vision loss

            If CrCl <30 mL/min, use loop diuretic instead of hydrochlorothiazide

            Hyperkalemia, particularly when coadministered with potassium-sparing diuretics, potassium supplements, or salt substitutes; concurrent therapy with hydrochlorothiazide may reduce the frequency of this effect; monitor serum potassium levels periodically

            Dual blockade of the renin-angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for renal function changes (including acute renal failure) compared to monotherapy

            Hypotension may occur in patients who are salt or volume-depleted (correct the volume depletion especially in patients receiving high dose diuretics)

            Hydrochlorothiazide can cause hypokalemia and hyponatremia; hypomagnesemia can result in hypokalemia which appears difficult to treat despite potassium repletion

            Drugs that inhibit the renin-angiotensin system can cause hyperkalemia; monitor serum electrolytes periodically

            Hyperuricemia may occur or gout may be precipitated in certain patients receiving thiazide therapy

            Hydrochlorothiazide may alter glucose tolerance and raise serum levels of cholesterol and triglycerides

            Thiazides may decrease urinary calcium excretion

            Instruct patients to protect skin from sun and undergo regular skin cancer screening

            Caution in aortic mitral stenosis, hepatic impairment, hypercholesterolemia, hypercalcemia, parathyroid disease, pre-existing renal insufficiency, systemic lupus erythematosus, bilateral renal artery stenosis or anuria


            Pregnancy & Lactation


            Therapy can cause fetal harm when administered to a pregnant woman; use of drugs that act on the renin-angiotensin system during second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death; most epidemiologic studies examining fetal abnormalities after exposure to antihypertensive use in first trimester have not distinguished drugs affecting reninangiotensin system from other antihypertensive agents; when pregnancy is detected, discontinue therapy as soon as possible

            Hypertension in pregnancy increases maternal risk for preeclampsia, gestational diabetes, premature delivery, and delivery complications (eg, need for cesarean section and postpartum hemorrhage); hypertension increases fetal risk for intrauterine growth restriction and intrauterine death; pregnant women with hypertension should be carefully monitored and managed accordingly

            Oligohydramnios in pregnant women who use drugs affecting the renin-angiotensin system in second and third trimesters of pregnancy can result in the following: reduced fetal renal function leading to anuria and renal failure, fetal lung hypoplasia, skeletal deformations, including skull hypoplasia, hypotension, and death; perform serial ultrasound examinations to assess intra-amniotic environment; fetal testing may be appropriate,

            Based on week of pregnancy; patients and physicians should be aware, however, that oligohydramnios may not appear until after fetus has sustained irreversible injury; closely observe infants with histories of in utero exposure to drug for hypotension, oliguria, and hyperkalemia and other symptoms of renal impairment; in neonates with a history of in utero exposure to drug, if oliguria or hypotension occurs, direct attention toward support of blood pressure and renal perfusion; exchange transfusion or dialysis may be required as means of reversing hypotension and/or substituting for disordered renal function

            Thiazides cross the placenta, and use of thiazides during pregnancy is associated with a risk of fetal or neonatal jaundice, thrombocytopenia, and possibly other adverse reactions that have occurred in adults


            There are no available data on the presence of irbesartan in human milk, effects on milk production, or breastfed infant; irbesartan or some metabolite of irbesartan is secreted in the milk of lactating rats

            Thiazides appear in human milk; because of potential for adverse effects on nursing infant, the drug is not recommended in breastfeeding women

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.





            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
            Email to Patient



            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient



            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.