Candesartan

Structural formula
General
Non-proprietary name	Candesartan
other names	2-ethoxy-1- {4- [2- (1 H -tetrazol-5-yl) phenyl] benzyl} benzimidazole-7-carboxylic acid (candesartan) ; (±) -1-Hydroxyethyl-2-ethoxy-1- [ p - ( o -1 H -tetrazol-5-ylphenyl) benzyl] -7-benzimidazole carboxylate (candesartan cilexetil ) ;
Molecular formula	C 24 H 20 N 6 O 3 (candesartan) ; C 33 H 34 N 6 O 6 (candesartan cilexetil) ;
Brief description	white to almost white powder
External identifiers / databases
EC number	604-138-8
ECHA InfoCard	100.132.654
PubChem	2541
DrugBank	DB00796
Wikidata	Q415970
Drug information
ATC code	C09 CA06
Drug class	Antihypertensive drugs
Mechanism of action	AT 1 antagonist
properties
Molar mass	440.45 g · mol -1 (Candesartan) ; 610.66 g · mol -1 (candesartan cilexetil) ;
Melting point	183-185 ° C ; 163 ° C (decomposition);
solubility	practically insoluble in water, slightly soluble in methanol (candesartan cilexetil)
safety instructions
	Please note the exemption from the labeling requirement for drugs, medical devices, cosmetics, food and animal feed
H and P phrases	H: 361-361d-411
	P: 201-280-308 + 313-273-391
Toxicological data	807 mg kg −1 ( LD 50 , mouse , ip )
	As far as possible and customary, SI units are used. Unless otherwise noted, the data given apply to standard conditions .

Candesartan is a drug that is used as an antihypertensive agent in essential arterial hypertension . It is also approved for the treatment of patients with heart failure and impaired left ventricular systolic function in addition to ACE inhibitors or in case of ACE inhibitor intolerance. Candesartan is a member of the group of AT ₁ antagonists . The effect of candesartan is based on a non-competitive inhibition of the AT ₁ receptor.

Candesartan cilexetil (prodrug)

The absorption ester candesartan cilexetil ( synonym: candesartan hexetil) is used pharmaceutically . This prodrug is only converted into the actual active form candesartan in the body when it passes through the mucous membrane of the small intestine.

After taking candesartan, side effects such as respiratory infection, dizziness, headache, high blood potassium, low blood pressure and impaired kidney function can often occur. Nevertheless, compared to other antihypertensive agents, candesartan is considered to have few side effects.

The bioavailability is 14% (candesartan cilexetil tablets) to 40% (candesartan cilexetil as a solution) and the plasma half-life is approx. 9 hours.

67% of candesartan is excreted in the biliary and 33% in the renal route . The elimination is largely unchanged. It is also metabolized to a lesser extent in the liver by the enzyme CYP2C9 .

Candesartan has a tetrazole ring in its chemical structure and is therefore one of those sartans that can potentially be endangered by the occurrence of nitrosamine impurities (" valsartan scandal ").

Trade names

Monopreparations : Atacand (protect) (D, A, CH), Blopress / Blopresid (D, A, CH), Pemzek (CH), Amias, various generics

Combination preparations: Atacand plus (forte) (D, A, CH), Blopress plus (D, A, CH), Pemzek plus (CH), various generics (D, A, CH)

Clinical information

Application areas (indications)

Candesartan is used to treat arterial hypertension, heart failure, and to prevent atrial fibrillation.

Adverse effects (side effects)

Candesartan can cause side effects. Common side effects include dizziness , headache , respiratory infections, low blood pressure, kidney problems, and increased potassium levels in the blood.

Individual evidence

↑ Data sheet for Atacand - FDA October 22, 2009 (PDF; 209 kB).
^ ^A ^b ^c The Merck Index : An Encyclopedia of Chemicals, Drugs, and Biologicals , 14th Edition (Merck & Co., Inc.), Whitehouse Station, NJ, USA, 2006; P. 281, ISBN 978-0-911910-00-1 .
↑ ^a ^b Registration dossier on 2-ethoxy-1 - {[2 '- (1H-tetrazol-5-yl) biphenyl-4-yl] methyl} -1H-benzimidazole-7-carboxylic acid ( GHS section ) at the European Chemicals Agency (ECHA), accessed December 28, 2019.

↑ Entry on candesartan in the ChemIDplus database of the United States National Library of Medicine (NLM), accessed on December 28, 2019.

↑ Red List online, as of September 2009.

↑ AM comp. D. Switzerland, as of September 2009.

↑ AGES-PharmMed, as of September 2009.

↑ CANDESARTAN AbZ - application, side effects, interactions. In: apotheken-umschau.de. November 9, 2015, accessed February 4, 2020 .

↑ Entry on Candesartan by Cora Health, accessed February 4, 2020

[FDA-1] Data sheet for Atacand - FDA October 22, 2009 (PDF; 209 kB).

[[[MERCK_Index]]-2] A ^b ^c The Merck Index : An Encyclopedia of Chemicals, Drugs, and Biologicals , 14th Edition (Merck & Co., Inc.), Whitehouse Station, NJ, USA, 2006; P. 281, ISBN 978-0-911910-00-1 .

[Registrierungsdossier-3] Registration dossier on 2-ethoxy-1 - {[2 '- (1H-tetrazol-5-yl) biphenyl-4-yl] methyl} -1H-benzimidazole-7-carboxylic acid ( GHS section ) at the European Chemicals Agency (ECHA), accessed December 28, 2019.

[ChemIDplus-4] Entry on candesartan in the ChemIDplus database of the United States National Library of Medicine (NLM), accessed on December 28, 2019.

[5] Red List online, as of September 2009.

[6] AM comp. D. Switzerland, as of September 2009.

[7] AGES-PharmMed, as of September 2009.

[8] CANDESARTAN AbZ - application, side effects, interactions. In: apotheken-umschau.de. November 9, 2015, accessed February 4, 2020 .

[9] Entry on Candesartan by Cora Health, accessed February 4, 2020