Candesartan cilexetil in cardiovascular disease

Physiologically based pharmacokinetic modeling of candesartan to predict the exposure in hepatic and renal impairment and elderly populations

Background

Candesartan cilexetil is a widely used angiotensin II receptor blocker with minimal adverse effects and high tolerability for the treatment of hypertension. Candesartan is administered orally as the prodrug candesartan cilexetil, which is wholly and swiftly converted to the active metabolite candesartan by carboxylesterase during absorption in the intestinal tract. In populations with renal or hepatic impairment, candesartan's pharmacokinetic (PK) behavior may be altered, necessitating dosage adjustments.

Objectives

This study was conducted to examine how the physiologically based PK (PBPK) model characterizes the PKs of candesartan in adult and geriatric populations and to predict the PKs of candesartan in elderly populations with renal and hepatic impairment.

Design

After developing PBPK models using the reported physicochemical properties of candesartan and clinical data, these models were validated using data from clinical investigations involving various dose ranges.

Methods

Comparing predicted and observed blood concentration data and PK parameters was used to assess the fit performance of the models.

Results

Doses should be reduced to approximately 94% of Chinese healthy adults for the Chinese healthy elderly population; approximately 92%, 68%, and 64% of that of the Chinese healthy adult dose in elderly populations with mild, moderate, and severe renal impairment, respectively; and approximately 72%, 71%, and 52% of that of the Chinese healthy adult dose in elderly populations with Child-Pugh-A, Child-Pugh-B, and Child-Pugh-C hepatic impairment, respectively.

Conclusion

The results suggest that the PBPK model of candesartan can be utilized to optimize dosage regimens for special populations.

Applying Different Techniques to Improve the Bioavailability of Candesartan Cilexetil Antihypertensive Drug

Purpose

The objective of this study was to compare different techniques to enhance the solubility and dissolution rate, and hence the bioavailability of candesartan cilexetil.

Methods

To achieve this target, various techniques were employed such as solid dispersions, inclusion complexes, and preparation of candesartan nanoparticles. Following the preparations, all samples were characterized for their physicochemical properties, and the samples of the best results were subjected to further bioavailability studies.

Results

Results of dissolution studies revealed an increase in the dissolution rate of all samples. The highest dissolution rate was achieved using solid dispersion of the drug with PVP K-90 (1:4). Physicochemical investigations (XR, DSC, and FT-IR) suggested formation of hydrogen bonding and changing in the crystalline structure of the drug. Regarding the inclusion complexes, more stable complex was formed between HP-β-CD and CC compared to β-CD, as indicated by phase solubility diagrams. Antisolvent method resulted in the preparation of stable nanoparticles, as indicated by ζ potential, with average particle size of 238.9 ± 19.25 nm using PVP K-90 as a hydrophilic polymer. The best sample that gave the highest dissolution rate (CC/PVP K-90 1:4) was allowed for further pharmacokinetic studies using UPLC MS/MS assay of rabbit plasma. Results showed a significant increase in the bioavailability of CC from ~15% to ~48%.

Conclusion

The bioavailability of CC was significantly improved from ~15% to ~48% when formulated as SDs with PVP K-90 with 1:4 drug:polymer ratio.

Effect of surfactants and hydrophilic polymers on the stability of an antihypertensive drug candesartan cilexetil: Evaluation by HPLC

OBJECTIVES

The objective of this study is to investigate the effect of surfactants (polysorbate 80 and sodium lauryl sulphate) and hydrophilic polymers (polyvinylpyrrolidone and polyethylene glycol 6000) on the stability of candesartan cilexetil under isothermal stress conditions (100°C, 48h).

METHODS

HPLC method was employed to evaluate the drug content and formation of degradation products in stress samples. Drug and degradation products were separated on Hypersil BDS C18 (250×4.6mm, 5μ) column using acetonitrile-water (pH 2.8) in the ratio of 85:15% v/v as a mobile phase.

RESULT

Similar degradation behaviour of drug was observed with polyvinylpyrrolidone, polyethylene glycol 6000 and polysorbate 80; four common degradation peaks were observed at the retention time of 3.7, 4.5, 7.8 and 11minutes. One extra common degradation peak of very low intensity was also observed with polyethylene glycol 6000 and polysorbate 80 at the retention time of 4.2min. The drug was eluting at the retention time of 5.4min. In the case of sodium lauryl sulphate, two prominent degradation peaks were observed at the retention time of 3.7 and 13.25min along with few very low-intensity degradation peaks.

CONCLUSION

The drug showed 41%, 64%, 72% and 98% degradation in presence of polyvinylpyrrolidone, polyethylene glycol 6000, polysorbate 80 and sodium lauryl sulphate, respectively.

Targeting angiotensin II type I receptors to reduce the risk of stroke in patients with hypertension

The incidence of stroke is rising among the elderly population. Hypertension is the single most important contributor to stroke, and hypertension treatment and control is the most important intervention to prevent it. Blood pressure reduction by any means will substantially reduce the risk of stroke. However, accumulating evidence indicates that angiotensin receptor blocker-based regimens may provide additional benefits in the prevention of stroke. This effect seems to be particularly prominent in high-risk patients and patients with isolated systolic hypertension. The pathophysiological mechanisms have not been clearly delineated, but favourable remodelling of the left atrium and reduction of the risk of atrial fibrillation has been suggested. In addition, blockade of the central AT1 receptors and stimulation of AT2 receptors and/or preferential reduction of central pressure by angiotensin receptor blockers may account for the beneficial protective effect.

Long-acting blood pressure reduction by candesartan cilexetil in patients with hypertension

Candesartan cilexetil is a highly potent and long-acting angiotensin II type I (AT1) receptor antagonist. This short review summarises results of clinical studies focusing on the duration of action of candesartan cilexetil. Results of previous clinical studies indicate that candesartan has the property to maintain a sustained blood pressure reduction for up to 48 h after dosing. Since lack of compliance is a known problem in patients with hypertension, these findings could be of particular clinical relevance.