TH is a 38 year old female that brings in a new prescription to your pharmacy for Edarbyclor 40/12.5 mg 1 tab PO QD. She says her provider mentioned this combination drug would replace one of her other blood pressure medications. Although she was initially hesitant to start a new antihypertensive, she was more open to the idea after learning that she would still be taking the same amount of pills every day.

PMH:

Type 2 Diabetes Mellitus
Hypertension
Hyperlipidemia

Obesity

Current medication list:
Hygroton 25 mg PO QD

Wegovy 2.4 mg SQ QWeek

Pravachol 40 mg PO QD

Norvasc 10 mg PO QD

Vitals and Labs from Recent Clinic Visit:

Wt: 114 kg

Ht: 5’2”
HR: 86 BPM
RR: 17 BPM
Temp: 98.8 F
BP: 140/88 mmHg

Which of the following is correct about this patient’s new prescription? Select all that apply. 

A. Edarbyclor should be stored in the refrigerator to ensure stability.

B. Edarbyclor contains a neprilysin inhibitor and an angiotensin receptor blocker (ARB).

C. Edarbyclor should not be taken in conjunction with Norvasc.

D. Edarbyclor may cause hypercalcemia or hypokalemia.

E. Edarbyclor has a boxed warning for fetal toxicity. 

Hypertension, defined as a blood pressure greater than or equal to 130/80 mmHg, affects almost half of adults in the United States and increases their risk for a variety of disease states including myocardial infarction, heart failure, and stroke. Treatment often involves antihypertensives and blood pressure monitoring to ensure a blood pressure maintained below 130/80 mmHg for most patients. Currently, there are a variety of medications used in the treatment of hypertension with many patients being on more than one antihypertensive at a time. Combination drugs allow providers to target a variety of pathways for hypertension while keeping a patient’s daily pill count at a minimum.

Edarbyclor (azilsartan/chlorthalidone) is a combination drug available for the treatment of hypertension comprised of an angiotensin receptor blocker (ARB) and a thiazide-like diuretic. Both ARBs and thiazide diuretics are considered first-line agents for hypertension, and Edarbyclor helps simplify a patient’s medication regimen by combining the two into one pill.

Answer A is incorrect. Edarbyclor is sensitive to moisture and should be dispensed in its original container to prevent deterioration. Patients should be advised to keep the medication in a dry, cool space. However it may be stored at room temperature. 

Answer B is incorrect. Edarbyclor contains an ARB (azilsartan) and thiazide-like diuretic (chlorthalidone).  Azilsartan works by binding to AT1 receptors and inhibiting the binding of angiotensin II. Chlorthalidone acts by inhibiting the Na/Cl channel in the distal convoluted tubule. An example of a combination drug containing a neprilysin inhibitor and an ARB is Entresto (sacubitril/valsartan).

Answer C is incorrect. Edarbyclor does not contain amlodipine or any other calcium channel blocker and has not been shown to interact with amlodipine. Patients may safely take these two medications together. The patient's current Hygroton (chlorthalidone) should most likely be discontinued as this would be duplicate therapy with the Edarbyclor. 

Answer D is correct. Edarbyclor since it contains a thiazide diuretic may induce hypercalcemia. Loop diuretics, such as furosemide, may cause hypocalcemia and are often a component of managing hypercalcemia. Thiazide diuretics may also induce hypokalemia so this should be routinely monitored. 

Answer E is correct. Edarbyclor can cause injury and fetal death due to the ARB component. Edarbyclor should not be used in pregnancy and should be stopped in patients discovered to be pregnant after initiation. 

Medications: Aziilsartan/Chlorthalidone (Edarbyclor), Chlorthalidone (Hygroton), Semaglutide (Wegovy), Rosuvastatin (Crestor), Amlodipine (Norvasc)

NAPLEX Competency Statements:

Area 2 - Identify Drug Characteristics

2.1 - Pharmacology, mechanism of action, or therapeutic class

2.2 - Commercial availability; prescription or non-prescription status; brand, generic, or biosimilar names; physical descriptions or how supplied

2.3 - Boxed warnings or REMS

2.4 - Pregnancy or lactation

Area 3 - Develop or Manage Treatment Plans

3.7 - Adverse drug effects, toxicology, or overdose

3.8 - Drug interactions

Area 5 - Compound, Dispense, or Administer Drugs, or Manage Delivery Systems

5.6 - Packaging, storage, handling, or disposal