Our library of drug research abstracts drawn from the medical literature is updated on a regular schedule, and you can be assured that new atacand research articles will be listed here shortly after becoming available to us.
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LC and LC-MS/TOF studies on stress degradation behaviour of candesartan cilexetil.
J Pharm Biomed Anal. 2009 May 15;
Mehta S, Shah RP, Priyadarshi R, Singh S
Stress degradation studies were conducted on candesartan cilexetil under the ICH prescribed conditions of hydrolysis (acidic, basic and neutral), photolysis, oxidation and thermal stress. Maximum degradation was observed on hydrolysis, especially in the neutral condition. The drug was also degraded significantly under photolytic conditions. However, it was stable to oxidative and thermal stress. A total of eight degradation products were formed, the separation of which was successfully achieved on a C-18 column employing a gradient method. In order to characterize each degradation product, a complete mass fragmentation pathway of the drug was initially established with the help of MS(n) and MS/TOF accurate mass studies. Subsequently, degradation products were also subjected to LC-MS/TOF investigations, which resulted in their fragmentation pattern and also accurate masses. The latter helped in the elucidation of the structure of all the degradation products, which was achieved through comparison of their fragmentation pattern with that of the drug. The major product was isolated and its structure was confirmed through NMR studies. On the whole, a more comprehensive fragmentation behaviour and degradation profile of the drug was established than reported in the literature.
Angiotensin II Receptor Blockage Prevents Diabetes-Induced Oxidative Damage in Rat Heart.
Folia Biol (Praha). 2009; 55(1): 11-6
Ozdemir S, Tandogan B, Ulusu NN, Turan B
Current findings suggest a role for the angiotensin II (Ang II) signalling pathway in generation of reactive oxygen species and diabetes-induced cardiac complications. In this study we aimed to investigate the effect of angiotensin II type 1 (AT1) receptor blockage on some antioxidant enzy mes such as glucose- 6-phosphate dehydrogenase (G6PD), 6-phoshogluconate dehydrogenase (6PGD), glutathione reductase (GR), glutathione-S-transferase (GST), gluta thione peroxidase (GSH-Px), and catalase (CAT) in the heart of streptozotocin (STZ)-induced diabetic rats. The effect of AT1 receptor blocker, candesartan-cilexetil (5 mg/kg/day for 4 weeks) was studied. Diabetes caused hyperglycaemia (4-fold of control) with significant increases in G6PD, 6PGD, GR, GSH-PX, CAT and no effect on GST in heart tissues as compared to normal control rats. Treatment of STZ-induced diabetic rats with candesartan-cilexetil had sig nificant beneficial effects on these parameters without any side effect on control rats. These results suggest that Ang II can take part in induction of oxidative stress in diabetic rat heart and that blockage of its activity by AT1 receptor blocker is potentially protective against diabetes-induced cellular damage.
Vasc Health Risk Manag. 2009; 5(1): 175-83
Baguet JP, Asmar R, Valensi P, Nisse-Durgeat S, Mallion JM
In hypertension and diabetes, early structural changes of the arterial wall precede or support atherosclerosis. There is evidence that some antihypertensive drugs exert an antiathero-sclerotic effect. Over 36 months, we investigated the effect of candesartan cilexetil (CC) on the common carotid intima-media thickness (IMT) vs amlodipine besylate (AML) in patients with type 2 diabetes and mild to moderate essential hypertension. After a 4-week wash-out period, 209 patients were randomized to either CC 8 mg or AML 5 mg once daily for a minimum of 1 month, after which, if BP was not normalized, the dosage was doubled, followed by the addition of hydrochlorothiazide 12.5 mg if necessary. No significant differences were observed between the two groups for change in IMT at M12 (-0.001 vs -0.027 mm/year for CC and AML respectively, p = 0.425), at M24 (-0.033 vs -0.019 mm per year respectively, p = 0.442), and at the last visit (-0.016 vs -0.039 mm per year respectively, p = 0.549). Within the group, comparisons did not show a significant difference in changes in IMT from baseline to the three visits. At the last visit, IMT regression was observed in 52.2% of patients receiving CC and in 51.3% of those receiving AML (p = 0.908). The augmentation in carotid lumen diameter from baseline was statistically greater in the AML group at the last visit (p = 0.034). BP variations during the study were similar in the two groups. The results of this study show that CC and AML treatments may alter identically the natural progression of carotid IMT in hypertensive type 2 diabetic patients.
Candesartan cilexetil in the treatment of chronic heart failure.
Vasc Health Risk Manag. 2009; 5(1): 257-64
Baguet JP, Barone-Rochette G, Neuder Y
The prevalence of heart failure is ever increasing around the world, particularly due to aging populations. Despite improvements in treatment over the last 20 years, the prognosis for heart failure remains poor. Among the treatments recommended for chronic heart failure, angiotensin-converting enzyme (ACE) inhibitors and beta-blockers are crucial, provided of course that they are not contraindicated. However, angiotensin II receptor blockers (ARBs) can also be a beneficial treatment option. Candesartan is a particular ARB, characterized by a strong binding affinity to the angiotensin II type 1 receptor and slow dissociation. The benefits of candesartan have been demonstrated by the CHARM programme, which showed that candesartan significantly reduces the incidence of cardiovascular death, hospital admissions for decompensated heart failure, and all-cause mortality in chronic heart failure patients with altered left ventricular systolic function, when added to standard therapies or as an alternative to ACE inhibitors when these are poorly tolerated. Furthermore, candesartan can protect against myocardial infarction, atrial fibrillation and diabetes. Tolerance to candesartan is good, but blood pressure and serum potassium and creatinine levels must be monitored.
Clin Drug Investig. 2009; 29(5): 293-304
Edes I,
Fixed-combination tablets of candesartan (orally administered as the pro-drug candesartan cilexetil and hereafter referred to as candesartan) and hydrochlorothiazide (HCTZ) 8/12.5 mg and 16/12.5 mg are effective and well tolerated. However, some patients require higher doses to attain target blood pressure, and combination tablets containing candesartan and HCTZ at the upper end of their respective dose ranges are now being developed. This study aimed to assess the antihypertensive effect and tolerability of the combination of candesartan 32 mg and HCTZ 25 mg versus candesartan 32 mg monotherapy, HCTZ 25 mg monotherapy, and placebo. This was a randomized, double-blind, parallel-group study, with 8 weeks of follow-up, carried out in primary-care outpatients. 1524 men or women (age 20-80 years) with mild to moderate primary hypertension and sitting diastolic blood pressure (DBP) 90-114 mmHg after 4 weeks' single-blind placebo treatment were included in the study. Candesartan/HCTZ 32/25 mg combination therapy, candesartan 32 mg monotherapy, HCTZ 25 mg monotherapy, and placebo, allocated in a 5 : 5 : 5 : 1 ratio, were administered once daily. The main outcome measure was adjusted (analysis of covariance) mean reductions in systolic blood pressure (SBP) and DBP. Mean reductions in SBP and DBP were significantly greater with candesartan/HCTZ 32/25 mg (21/14 mmHg) than with candesartan 32 mg (13/9 mmHg), HCTZ 25 mg (12/8 mmHg) or placebo (4/3 mmHg) [p < 0.001for all comparisons]. The proportion of patients with controlled blood pressure (SBP
[Pharmacological characteristics of ARB and potential strategy to develop novel ARB]
Nippon Rinsho. 2009 Apr; 67(4): 812-8
Kim-Mitsuyama S
Six AT1 receptor blockers (ARBs) are clinically available in Japan. There seems to be some difference among 6 ARBs in terms of basic and clinical pharmacological characteristics. However, the clinical significance of the difference among 6 ARBs in pharmacological characteristics remains to be fully determined. The combination of ARB with pioglitazone or statin seems to be more effective for treatment of cardiovascular diseases than either monotherapy, through more attenuation of tissue oxidative stress, indicating the clinical usefulness of these combination therapies. In this review, the potential strategy to develop novel ARBs is discussed.
Clin Drug Investig. 2009; 29(4): 257-64
Furukawa T, Hatsuno T, Ueno Y, Nagaoka K, Watari Y, Yamakawa T, Sagawa T, Isshiki T
BACKGROUNDS AND METHODS: A higher degree of clinical efficacy with olmesartan compared with other angiotensin receptor blockers, has been reported by several sources. In this study of 31 examples of cases of essential hypertension, Holter electrocardiogram, ambulatory blood pressure monitoring and pulse wave velocity (PWV) measurements were performed before and after substituting olmesartan 20 mg for candesartan 8 mg antihypertensive drug therapy. RESULTS: Following the therapeutic change, daily average systolic and diastolic blood pressures were decreased by 6.7 +/- 9.3 mmHg and 3.6 +/- 8.3 mmHg, respectively, with olmesartan 20 mg; PWV was also significantly decreased. Holter electrocardiogram heart rate variability spectral analysis demonstrated that none of the very low frequency (VLF), high frequency (HF) and low frequency (LF)/HF components were significantly altered. However, a significant correlation was observed between the LF/HF component and blood pressure difference, when blood pressure and heart rate variability components in each individual case were studied. CONCLUSION: This study shows that olmesartan has a stronger antihypertensive effect in comparison to candesartan, and does not generate reflex sympathoexcitatory activity.
Clin Res Cardiol. 2009 Mar 18;
Mitrovic V, Appel KF, Proskynitopoulos N, Dereli S, Hamm CW
AIMS: In the present study, we investigated the efficacy and safety of candesartan cilexetil (candesartan) as "add-on" treatment in congestive heart failure (CHF) in daily practice. METHODS AND RESULTS: In this open-label, multicenter study 414 CHF outpatients (NYHA II/III) with left ventricular ejection fraction (LVEF) 200 pg/ml at baseline were enrolled. Patients were treated with standard therapy including at least one angiotensin converting enzyme inhibitor in addition to another CHF drug; 91% of the patients received beta-blockers. Candesartan was uptitrated to 32 mg/day (target dose if tolerated) during 6 weeks followed by constant dosing over 16 weeks. The primary endpoint plasma BNP was significantly reduced by 25% at week 22 (from 394 to 295 pg/ml, P < 0.0001 vs. baseline). Candesartan produced early and sustained improvements of plasma BNP/NT-pro-BNP, LVEF, and quality of life (SF-36) compared to baseline. Of patients on beta-blockers, 37% improved towards NYHA II/I at week 22 (P < 0.0001) and 53.5% of the patients in NYHA III at baseline improved into NYHA II/I at week 22 (n = 232, P < 0.0001). Candesartan was well tolerated; no unexpected findings were reported besides known adverse reactions including hypotension, hyperkalemia, and serum creatinine elevations. CONCLUSION: Candesartan "add-on" treatment provides a good benefit/risk ratio in CHF outpatients in daily practice, although high-risk patients should be managed with frequent monitoring of BP, serum potassium, and renal function.
Development and characterization of solid oral dosage form incorporating candesartan nanoparticles.
Pharm Dev Technol. 2009 Feb 23; 1-9
Nekkanti V, Pillai R, Venkateshwarlu V, Harisudhan T
Sparingly water-soluble drugs such as candesartan cilexetil offer challenges in developing a drug product with adequate bioavailability. The objective of the present study was to develop a tablet dosage form of candesartan cilexetil incorporating drug nanoparticles to increase its saturation solubility and dissolution rate for enhancing bioavailability while reducing variability in systemic exposure. The bioavailability of candesartan cilexetil is dissolution limited following oral administration. To enhance bioavailability and overcome variability in systemic exposure, a nanoparticle formulation of candesartan cilexetil was developed. Candesartan cilexetil nanoparticles were prepared using a wet bead milling technique. The milled nanosuspension was converted into solid intermediate using a spray drying process. The nanosuspensions were characterized for particle size before and after spray drying. The spray dried nanoparticles were blended with excipients for tableting. The saturation solubility and dissolution characteristics of the nanoparticle formulation were investigated and compared with commercial candesartan cilexetil formulation. The drug nanoparticles were evaluated for solid-state transitions before and after milling. This study demonstrated that tablet formulation incorporating drug nanoparticles showed significantly faster rate of drug dissolution in a discriminating dissolution medium as compared to commercially available tablet formulation. Systemic exposure studies in rats indicated a significant increase in the rate and extent of drug absorption.
Supramaximal dose of candesartan in proteinuric renal disease.
J Am Soc Nephrol. 2009 Apr; 20(4): 893-900
Burgess E, Muirhead N, Rene de Cotret P, Chiu A, Pichette V, Tobe S,
High levels of proteinuria predict renal deterioration, suggesting that interventions to reduce proteinuria may postpone the development of severe renal impairment. This multicenter Canadian trial evaluated whether supramaximal dosages of candesartan would reduce proteinuria to a greater extent than the maximum approved antihypertensive dosage. The authors randomly assigned 269 patients who had persistent proteinuria (> or =1 g/d) despite 7 wk of treatment with the highest approved dosage of candesartan (16 mg/d) to 16, 64, or 128 mg/d candesartan for 30 wk. The median serum creatinine level was 130.0 micromol/L (1.47 mg/dl), and the median urinary protein excretion was 2.66 g/d; most (53.9%) patients had diabetic nephropathy. The mean difference of the percentage change in proteinuria for patients receiving 128 mg/d candesartan compared with those receiving 16 mg/d candesartan was -33.05% (95% confidence interval -45.70 to -17.44; P < 0.0001). Reductions in BP were not different across the three treatment groups. Elevated serum potassium levels (K+ > 5.5 mEq/L) led to the early withdrawal of 11 patients, but there were no dosage-related increases in adverse events. In conclusion, proteinuria that persists despite treatment with the maximum recommended dosage of candesartan can be reduced by increasing the dosage of candesartan further, but serum potassium levels should be monitored during treatment.