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Candesartan

Classification: A

Drug products: Amias, Atacand, Atacand Plus, Atacand®, Atacand® Plus, Blopresid Comp, Blopress Comp, Candemox Comp, Candesarstad, Candesarstad Comp, Candesartan Actavis, Candesartan Krka, Candesartan Navamedic, Candesartan Orion, Candesartan Ranbaxy, Candesartan Sandoz, Candesartan/Hydrochlorothiazide 2care4, Candesartan/Hydrochlorothiazide Actavis, Candesartan/Hydrochlorothiazide Krka, Candesartan/Hydrochlorothiazide Navamedic, Candesartan/Hydrochlorothiazide Orion, Candesartan/Hydrochlorothiazide STADA, Candesartan/Hydrochlorothiazide Teva, Candexetil, Candexetil comp, Kairasec, Kandesartan Ebb, Kandrozid, Racanda, Ratacand Plus

ATC code: C09CA06, C09DA06

Substances: candesartan, candesartan cilexetil

Summary

The antihypertensive effect of candesartan is similarin men and women. A study has shown Caucasian women and men to achieve a larger blood pressure reduction compared to African-American women and men. Candesartan reduces the risk of cardiovascular death and hospitalization for heart failure equally in men and women with heart failure.
 
The present evidence concerning differences between men and women is limited and do not motivate differentiation in dosing or treatment.

Additional information

Pharmacokinetics and dosing

Pharmacokinetic studies have found no sex differences in the pharmacokinetic parameters in hypertensive patients receiving candesartan [1-5]. 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 sex and weight [5]. Based on the pharmacokinetics of candesartan, no initial dosage adjustment based on 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) has shown a clinically significant dose-dependent antihypertensive effect of candesartan, irrespective of sex [6].

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 [7].

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 this results. However, the effect of candesartan (4-32 mg once daily) was similar in men and women [8].

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 sex [9, 10].

Reproductive health issues

Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).

Updated: 2019-02-26

Date of litterature search: 2014-01-21

References

  1. 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
  2. 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
  3. Atacand (candesartan cilexetil). DailyMed [www]. US National Library of Medicine. [updated 2013-04-01, cited 2014-01-21]. länk
  4. Gleiter CH, Mörike KE. Clinical pharmacokinetics of candesartan. Clin Pharmacokinet. 2002;41:7-17. PubMed
  5. 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
  6. 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
  7. 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
  8. 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
  9. Gleiter CH, Jägle C, Gresser U, Mörike K. Candesartan. Cardiovasc Drug Rev. 2004;22:263-84. PubMed
  10. 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
  11. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2015 [cited 2016-04-05.] länk

Authors: Linnéa Karlsson Lind, Desirée Loikas

Reviewed by: Mia von Euler

Approved by: Karin Schenck-Gustafsson

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