<p><strong>Renal impairment</strong>: no dosage adjustment is necessary in patients with impaired renal function. A&nbsp;lower starting dose of Irbesartan 75 mg should be considered for patients undergoing&nbsp;haemodialysis.&nbsp;Intravascular volume depletion: volume and/or sodium depletion should be corrected prior to&nbsp;administration of Irbesartan.&nbsp;<br />
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<strong>Hepatic impairment</strong>: no dosage adjustment is necessary in patients with mild to moderate&nbsp;hepatic impairment. There is no clinical experience in patients with severe hepatic impairment.<br />
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<strong>Hypertensive patients with&nbsp;type 2 diabetes and renal disease</strong>: the effects of irbesartan both on renal and&nbsp;cardiovascular events were not uniform across all subgroups, in an analysis carried&nbsp;out in the study with patients with advanced renal disease. In particular, they&nbsp;appeared less favourable in women and non-white subjects.<br />
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<strong>Hyperkalaemia</strong>: as with&nbsp;other drugs that affect the renin-angiotensin-aldosterone system, hyperkalaemia may&nbsp;occur during the treatment with Irbesartan, especially in the presence of renal&nbsp;impairment, overt proteinuria due to diabetic renal disease, and/or heart failure.&nbsp;Close monitoring of serum potassium in patients at risk is recommended.<br />
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<strong>Aortic and&nbsp;mitral valve stenosis, obstructive hypertrophic cardiomyopathy</strong>: as with other&nbsp;vasodilators, special caution is indicated in patients suffering from aortic or mitral&nbsp;stenosis, or obstructive hypertrophic cardiomyopathy.<br />
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<strong>Primary aldosteronism</strong>:&nbsp;patients with primary aldosteronism generally will not respond to anti-hypertensive&nbsp;drugs acting through inhibition of the renin-angiotensin system. Therefore, the use&nbsp;of Irbesartan is not recommended.<br />
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<strong>General</strong>: in patients whose vascular tone and&nbsp;renal function depend predominantly on the activity of the renin-angiotensinaldosterone&nbsp;system (e.g. patients with severe congestive heart failure or underlying&nbsp;renal disease, including renal artery stenosis), treatment with angiotensin converting&nbsp;enzyme inhibitors or angiotensin-II receptor antagonists that affect this system has&nbsp;been associated with acute hypotension, azotaemia, oliguria, or rarely acute renal&nbsp;failure. As with any anti-hypertensive agent, excessive blood pressure decrease in&nbsp;patients with ischaemic cardiopathy or ischaemic cardiovascular disease could result&nbsp;in a myocardial infarction or stroke.</p>