OBJECT DRUGS
Angiotensin Receptor Blockers (ARBs):
- Azilsartan (Edarbi)
- Candesartan (Atacand)
- Eprosartan (Teveten)
- Irbesartan (Avapro)
- Losartan (Cozaar)
- Olmesartan (Benicar)
- Telmisartan (Micardis)
- Valsartan (Diovan)
PRECIPITANT DRUGS
Comment:
Patients on ACE inhibitors have developed severe hypotension after starting tizanidine therapy; theoretically, a similar reaction could occur if tizanidine were added to ARB therapy. Tizanidine, like the antihypertensive drug clonidine, is an alpha-2 adrenergic agonist, and may have additive hypotensive effects with ARBs.
Class 3: Assess Risk & Take Action if Necessary
- Consider Alternative:In patients taking an ARB, consider using muscle relaxants other than tizanidine (that are not alpha-2 adrenergic agonists). Some other muscle relaxants can also sometimes cause hypotension, but the risk is probably less than for tizanidine.
- Monitor: If tizanidine is used in a patient taking an ARB, monitor cardiovascular status carefully for evidence of an acute hypotensive reaction.