ncomitantly should be monitored for changes in volume status, renal function, and glycemic control.
Dapagliflozin; Metformin: Angiotensin II receptor antagonists (ARBs) may enhance the hypoglycemic effects of metformin by improving insulin sensitivity. In addition, angiotensin II receptor antagonists have been associated with a reduced incidence in the development of new-onset diabetes in patients with hypertension or other cardiac disease. ARBs may rarely reduce renal function, a risk factor for reduced renal clearance of metformin. Patients receiving these drugs together should be monitored for changes in renal function and glycemic control. When dapagliflozin is initiated in patients already receiving angiotensin II receptor antagonists (ARBs), symptomatic hypotension can occur. Patients with impaired renal function, low systolic blood pressure, or who are elderly may be at a greater risk. Before initiating dapagliflozin in patients with one or more of these characteristics, volume status should be assessed and corrected. Monitor for signs and symptoms after initiating therapy. In addition, dapagliflozin can lead to hyperkalemia. Patients with renal impairment who are taking medications that interfere with potassium excretion, such as medications that interfere with the renin-angiotensin-aldosterone (RAA) system, are more likely to develop hyperkalemia. Monitor serum potassium levels periodically. ARBs may enhance the hypoglycemic effects of dapagliflozin by improving insulin sensitivity.ARBs have been associated with a reduced incidence in the development of new-onset diabetes in patients with hypertension or other cardiac disease. Patients receiving these drugs concomitantly should be monitored for changes in volume status, renal function, and glycemic control.
Darunavir; Cobicistat: Caution is warranted when cobicistat is administered with valsartan as there is a potential for increased valsartan concentrations. Valsartan is a substrate of organic anion transporting polypeptide (OATP)1B1. Cobicistat is an inhibitor of OATP.
Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: Coadministration of valsartan and regimens containing paritaprevir may result in elevated valsartan plasma concentrations. A valsartan dose reduction, and close monitoring for adverse events (i.e., hypotension and worsening renal function) are advised during coadministration. If adverse events are observed, consider further reductions in valsartan dose or an alternative to the angiotensin receptor blocker. Valsartan is a substrate of the organic anion transporting polypeptides (OATP) and paritaprevir is an OATP1B1 and OATP1B3 inhibitor. Valsartan is a substrate of the hepatic efflux transporter MRP2 and ritonavir is an inhibitor of MRP2. Coadministration may increase systemic exposure to valsartan. Patients should be monitored for adverse effects of valsartan during coadministration.
Desloratadine; Pseudoephedrine: The cardiovascular effects of sympathomimetics may reduce the antihypertensive effects produced by angiotensin II receptor antagonists.
Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: The cardiovascular effects of sympathomimetics may reduce the antihypertensive effects produced by angiotensin II receptor antagonists.
Dexmedetomidine: In general, the concomitant administration of dexmedetomidine with antihypertensive agents could lead to additive hypotensive effects. Dexmedetomidi |
