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Principles of Heart Failure Pharmacotherapy
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Erika L. Hellenbart, Stephanie Dwyer Kaluzna, Robert J. DiDomenico
Candesartan is a prodrug that is primarily eliminated renally.13 Losartan undergoes hepatic metabolism and has an active metabolite, E3174, that is more potent and has a longer half-life than losartan.13 Valsartan is cleared predominantly in the feces as unchanged drug.13 Candesartan and losartan are dosed once daily, whereas valsartan is dosed twice daily when used for the treatment of HF.
Cardiovascular Drugs
Published in Radhwan Nidal Al-Zidan, Drugs in Pregnancy, 2020
Risk Summary: Candesartan Cilexetil is contraindicated during the 2nd and 3rd Trimesters because the pregnancy experience in humans showed a profound potentiality of teratogenicity and severe fetal toxicity associated with its use during this period.
Blood Pressure Management in Acute Stroke
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Efstathios Manios, Eleni Koroboki, Konstantinos Vemmos
In the ACCESS study (Acute Candesartan Cilexetil Therapy in Stroke Survivors), 339 patients with acute IS and BP values greater than 180/105 mmHg were randomized to oral candesartan or placebo within 36 hours after admission and maintained on study drug for 7 days after randomization (8). The two groups did not differ regarding functional outcome and risk of stroke recurrence at 3 and 12 months, respectively. However, candesartan significantly reduced mortality and vascular events during the 12-month follow-up. The superiority of candesartan versus placebo over the secondary endpoint of the study triggered the design of a larger study. In the SCAST study (Scandinavian Candesartan Acute Stroke Trial), a phase III RCT, 2029 patients with acute IS (85%) or ICH (15%) and SBP (>140 mmHg) were randomized to oral candesartan or placebo using a design similar to ACCESS (9). The composite endpoint of major cardiovascular events did not differ between the two groups at 6 months. However, patients treated with candesartan had a worse functional outcome compared to those receiving placebo. In addition, a SCAST substudy showed that in patients with moderate to severe carotid artery disease treated with candesartan, progressive stroke occurred more frequently than in the placebo group (10).
The use of a gene expression signature and connectivity map to repurpose drugs for bipolar disorder
Published in The World Journal of Biological Psychiatry, 2020
Srisaiyini Kidnapillai, Chiara C. Bortolasci, Madhara Udawela, Bruna Panizzutti, Briana Spolding, Timothy Connor, Andrew Sanigorski, Olivia M. Dean, Tamsyn Crowley, Stéphane Jamain, Laura Gray, Elizabeth Scarr, Marion Leboyer, Brian Dean, Michael Berk, Ken Walder
Additionally, inflammation in mood disorders can also be regulated by the renin–angiotensin system in the central nervous system (Williams et al. 2016). A drug repurposing study matched the Wellcome Trust Case–Control Consortium genome-wide association data and drug profiles from three drug databases, finding two drug matches: imipramine, an antidepressant, and valsartan, an angiotensin antagonist (Grover et al. 2014). Candesartan, also an angiotensin antagonist, has been shown to have anti-manic efficacy in an animal model and reversed amphetamine-induced alterations in glutathione, markers of lipid peroxidation (thiobarbituric acid reactive substances), inflammation (tumor necrosis factor α) and neurotrophins (brain-derived neurotrophic factor) (de Souza Gomes et al. 2015). More recently, an epidemiological study found evidence that use of angiotensin-converting enzyme (ACE) inhibitors decreased the occurrence of mood disorders (Williams et al. 2016). In this context, the ACE inhibitor from our CMap analysis, rescinnamine, is a promising candidate drug for repurposing to treat BD.
Design and optimization of candesartan loaded self-nanoemulsifying drug delivery system for improving its dissolution rate and pharmacodynamic potential
Published in Drug Delivery, 2020
Ravinder Verma, Deepak Kaushik
Candesartan (kan” de sar’ tan) is a BCS II class drug that is widely used alone or in combination with other agents for therapy of hypertension and heart failure. It inhibits the renin-angiotensin system by blocking the angiotensin II type 1 receptor, which prevents the vasoconstriction and volume expansion induced by circulating angiotensin II, resulting in its antihypertensive potential. It is commercially available in 4, 8, 16 and 32 mg tablets generically (Candesar/Candosa/blopress/Camperten), under the trade name Atacand. It may be brought into play to treat hypertension, isolated systolic hypertension, left ventricular hypertrophy and diabetic nephropathy. It may also be used as a second-line drug for the treatment of heart failure, systolic dysfunction, myocardial infarction and coronary artery disease. Its typical dose is 16–32 mg “quaque die” in adults which is used for the long term (Zhao & Wang, 2018).
Treatment of hypertension in the elderly in 2017/2018 - what’s new?
Published in Expert Opinion on Pharmacotherapy, 2019
The second study that contributed to influence the recent recommendations is the Heart Outcomes Prevention Evaluation (HOPE)–3 trial [32]. The goal of this trial was to assess whether antihypertensive therapy reduces the risk of cardiovascular events in persons at intermediate cardiovascular risk and with a lower BP (mean 138/81 mmHg at baseline). The 12,705 participants at intermediate risk who did not have cardiovascular disease were randomized to receive either candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day or placebo. The trial included men 55 years of age or older and women 65 years of age or older. Mean age was actually 65.8 years. Therapy with candesartan/hydrochlorothiazide was not associated with a lower rate of major cardiovascular events than placebo in the overall group of patients. Yet, patients in the upper third of systolic BP (>143.5 mm Hg) had significantly lower rates of the primary endpoint (death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke) than those in the placebo group. These data suggest that drug therapy reduces the risk of cardiovascular events in patients with uncomplicated mild hypertension only if their systolic BP is above 140 mmHg.