Kandesartan
Klassificering: AATC kod: C09CA06, C09DA06
Sammanfattning
Den blodtryckssänkande effekten av kandesartan är likvärdig hos kvinnor och män.
Kandesartan minskar risken för kardiovaskulär död och sjukhusinläggning för hjärtsvikt lika effektivt hos kvinnor och män.
Additional information
Pharmacokinetics and dosing
Pharmacokinetic studies have found no sex differences in the pharmacokinetic parameters of candesartan in hypertensive patients [1-5] or in healthy adults [6]. One study reported that AUC/dose corrected for body mass did not differ between men and women [4]. A small pharmacokinetic study in hypertensive children (in total 10), receiving a single dose of candesartan (0.2 mg/kg), reported that the pharmacokinetic profile was independent of patient’s sex and weight [5]. Based on the pharmacokinetics of candesartan, no initial dosage adjustment based on patient’s sex is considered necessary [3].
Effects
A meta-analysis (657 men, 771 women) of six European randomized, double-blind, placebo-controlled studies using candesartan (doses ranged from 2-16 mg once daily) shows a clinically significant dose-dependent antihypertensive effect of candesartan, irrespective of patient’s sex [7].
In a multicenter study (203 men, 236 women), African-American and non-Hispanic white subjects with essential hypertension were treated with candesartan, 32 mg/day for 6 weeks. Blood pressure (BP) response to candesartan in non-Hispanic white women and men were greater than in their African-American counterparts. Non-Hispanic white women had the largest fall in systolic BP compared with all other groups (African American men and women and non-Hispanic white men). Diastolic BP also decreased more in non-Hispanic white women than in African Americans of either sex, but not more than in non-Hispanic white men [8].
An analysis of all three CHARM heart failure studies (5199 men, 2400 women) showed that the risk reduction in cardiovascular death or heart failure hospitalization was lower in women regardless of treatment. More women than men had preserved left ventricular ejection fraction, which might explain these results. However, the effect of candesartan (4-32 mg once daily) was similar in men and women [9].
Adverse effects
Tolerability profile of candesartan during long-term studies is similar to that of short-term clinical trials and did not appear to be related to patient’s sex [10, 11].
Reproductive health issues
Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).
Försäljning på recept
Nästan lika många kvinnor och män hämtade ut tabletter innehållande kandesartan (ATC-kod C09CA06) på recept i Sverige år 2019, totalt 145 222 kvinnor och 146 101 män. Det motsvarar 29 respektive 28 personer per tusen invånare. Andelen som hämtat ut läkemedel var högst i åldersgruppen 75 år och äldre hos båda könen. I åldersgruppen yngre än 79 år var tabletter innehållande kandesartan i genomsnitt 1,2 gånger vanligare hos män medan i åldersgruppen 80 år och äldre var det i genomsnitt 1,1 gånger vanligare hos kvinnor [12].
Fler män än kvinnor hämtade ut tabletter innehållande kombination av kandesartan och hydroklortiazid (ATC-kod C09DA06) på recept i Sverige år 2019, totalt 33 778 män och 29 478 kvinnor. Det motsvarar 6,6 respektive 5,8 personer per tusen invånare. Andelen som hämtat ut läkemedel var högst i åldersgruppen 65-84 år hos män och i åldersgruppen 70-84 år hos kvinnor. I åldersgruppen yngre än 79 år var tabletter innehållande kombination av kandesartan och hydroklortiazid i genomsnitt 1,9 gånger vanligare hos män och i åldersgruppen 80 år och äldre i genomsnitt 1,2 gånger vanligare hos kvinnor [12].
Uppdaterat: 2020-05-13
Litteratursökningsdatum: 2019-10-10
Referenser
- Meineke I, Feltkamp H, Högemann A, Gundert-Remy U. Pharmacokinetics and pharmacodynamics of candesartan after administration of its pro-drug candesartan cilexetil in patients with mild to moderate essential hypertension--a population analysis. Eur J Clin Pharmacol. 1997;53:221-8. PubMed
- Hübner R, Högemann AM, Sunzel M, Riddell JG. Pharmacokinetics of candesartan after single and repeated doses of candesartan cilexetil in young and elderly healthy volunteers. J Hum Hypertens. 1997;11 Suppl 2:S19-25. PubMed
- Atacand (candesartan cilexetil). DailyMed [www]. US National Library of Medicine. [updated 2018-10-01, cited 2019-10-11]. länk
- Gleiter CH, Mörike KE. Clinical pharmacokinetics of candesartan. Clin Pharmacokinet. 2002;41:7-17. PubMed
- Schaefer F, van de Walle J, Zurowska A, Gimpel C, van Hoeck K, Drozdz D et al. Efficacy, safety and pharmacokinetics of candesartan cilexetil in hypertensive children from 1 to less than 6 years of age. J Hypertens. 2010;28:1083-90. PubMed
- Food and Drug Administration (FDA). Atacand (candesartan). Drugs@FDA [www]. [updated 2002-04-11, cited 2019-10-11]. länk
- Elmfeldt D, George M, Hübner R, Olofsson B. Candesartan cilexetil, a new generation angiotensin II antagonist, provides dose dependent antihypertensive effect. J Hum Hypertens. 1997;11 Suppl 2:S49-53. PubMed
- Canzanello VJ, Baranco-Pryor E, Rahbari-Oskoui F, Schwartz GL, Boerwinkle E, Turner ST et al. Predictors of blood pressure response to the angiotensin receptor blocker candesartan in essential hypertension. Am J Hypertens. 2008;21:61-6. PubMed
- Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL et al. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet. 2003;362:759-66. PubMed
- Gleiter CH, Jägle C, Gresser U, Mörike K. Candesartan. Cardiovasc Drug Rev. 2004;22:263-84. PubMed
- Sever P, Holzgreve H. Long-term efficacy and tolerability of candesartan cilexetil in patients with mild to moderate hypertension. J Hum Hypertens. 1997;11 Suppl 2:S69-73. PubMed
- Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2019 [cited 2020-03-10.] länk
Faktagranskat av: Mia von Euler
Godkänt av: Karin Schenck-Gustafsson