6/10/2023

Janusmed kön och genus

Janusmed kön och genus – Ratacand Plus

Janusmed kön och genus är ett kunskapsstöd som tillhandahåller information om köns- och genusaspekter på läkemedelsbehandling. Kunskapsstödet är avsedd främst för hälso- och sjukvårdspersonal. Texterna är generella och ska inte ses som behandlingsriktlinjer. Det är alltid behandlande läkare som ansvarar för patientens medicinering.

För att komma till startsidan för Janusmed kön och genus och för att göra sökningar klicka här.

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A A
A A

Hydroklortiazid

Hydroklortiazid

Klass: A

Produkter

Amiloferm, Amiloferm mite, Atacand Plus, Blopresid Comp......

Amiloferm, Amiloferm mite, Atacand Plus, Blopresid Comp, Blopress Comp, Candemox Comp, Candesarstad Comp, Candesartan/Hydrochlorothiazide 2care4, Candesartan/Hydrochlorothiazide Actavis, Candesartan/Hydrochlorothiazide Bijon, Candesartan/Hydrochlorothiazide Krka, Candesartan/Hydrochlorothiazide Navamedic, Candesartan/Hydrochlorothiazide Orion, Candesartan/Hydrochlorothiazide STADA, Candesartan/Hydrochlorothiazide Teva, Candexetil comp, Corixil Comp, Cozaar Comp, Cozaar Comp Forte, Diovan Comp, Enalapril Comp STADA, Enalapril Comp Sandoz, Enalapril comp ratiopharm, Enalapril/Hydrochlorothiazide 2care4, Enalapril/Hydrochlorothiazide Medical Valley, Enalapril/Hydrochlorothiazide Mylan, Enalapril/Hydrochlorothiazide Orion, Enalapril/Hydrochlorothiazide Teva, Esidrex, Etilbo, Fortzaar Comp Forte, Forzaar Comp Forte, Hydrochlorothiazide Bluefish, Hydrochlorothiazide Orifarm, Hydrochlorothiazide Orion, Hydroklortiazid Ebb, Hydroklortiazid Evolan, Klomentan Comp, Linatil comp, Linatil comp mite, Lisinopril/Hydrochlorthiazid Sandoz, Lisinopril/Hydroklortiazid Actavis, Lisinopril/Hydroklortiazid Copyfarm, Lisinopril/Hydroklortiazid Ebb, Lisinopril/Hydroklortiazid STADA, Losamyl Comp, Losarstad Comp, Losartan/Hydrochlorothiazide Aurobindo, Losartan/Hydrochlorothiazide Bluefish, Losartan/Hydrochlorothiazide Krka, Losartan/Hydrochlorothiazide Medical Valley, Losartan/Hydrochlorothiazide Sandoz, Losartan/Hydrochlorothiazide Teva, Losartan/Hydroklortiazid Actavis, Losartan/Hydroklortiazid Orifarm, Losartan/hydroklortiazid Jubilant, Losatrix Comp, Losatrix comp, Losazid Comp, Losazid Comp Forte, Marozid, Moduretic, Moduretic mite, Normorix, Normorix mite, Ramipril/Hydrochlorothiazide Krka, Ramipril/Hydroklortiazid 2care4, Ramipril/Hydroklortiazid Actavis, Ramipril/Hydroklortiazid Alternova, Ramipril/Hydroklortiazid Ebb, Ramipril/Hydroklortiazid HEXAL, Ramipril/Hydroklortiazid Orifarm, Ratacand Plus, Renitec comp., Rocaval, Sparkal, Sparkal mite, Synerpril, Tanlozid, Tareg Comp, Triatec comp, Triatec comp mite, Valsartan/Hydrochlorothiazide 2care4, Valsartan/Hydrochlorothiazide Krka, Valsartan/Hydrochlorothiazide Rivopharm, Valsartan/Hydrochlorothiazide Sandoz, Valsartan/Hydrochlorothiazide Teva, Valsartan/Hydroklortiazid Abacus Medicine, Valsartan/Hydroklortiazid Ebb, Valsartan/Hydroklortiazid Jubilant, Valsartore Comp, Valtsu comp, Zestoretic
ATC-koder

C03AA03, C03EA01, C09BA02, C09BA03, C09BA05, C09DA01......

C03AA03, C03EA01, C09BA02, C09BA03, C09BA05, C09DA01, C09DA03, C09DA06
Substanser

hydroklortiazid

hydroklortiazid
Sammanfattning

Studier har visat motsägande resultat huruvida det finns eller inte finns könsskillnader i den blodtryckssänkande effekten av hydroklortiazid.

Vid spontanrapportering har allvarliga biverkningar av hydroklortiazid, såsom akut lungödem och akut allergisk interstitiell lunginflammation, rapporterats förekomma oftare hos kvinnor än hos män. Skivepitelcancer (ej lokaliserad på läppen), har rapporterats vara vanligare hos kvinnor. För övrig hudcancer av icke-melanomtyp sågs inga könsskillnader.

Studier har visat motsägande resultat huruvida det finns eller inte finns könsskillnader i den blodtryckssänkande effekten av hydroklortiazid. Vid spontanrapportering har allvarliga biverkningar av hydroklortiazid, såsom akut lungödem och akut allergisk interstitiell lunginflammation, rapporterats förekomma oftare hos kvinnor än hos män. Skivepitelcancer (ej lokaliserad på läppen), har rapporterats vara vanligare hos kvinnor. För övrig hudcancer av icke-melanomtyp sågs inga könsskillnader.
Background

Pharmacokinetics and dosing
No studies with a clinically relevant sex analysis regarding the pharmacokinetics or dosing of hydrochlorothiazide have been found.

Effects
Studies report conflicting results on sex differences in response to hydrochlorothiazide (HCTZ ). Results from the randomized, double-blind HANE study (113 men, 102 women) showed similar antihypertensive response rates to HCTZ (12.5-50 mg daily over 48 weeks) between men and women [1]. However, a prospective clinical trial (1209 men, 2326 women) found that women had a better diastolic BP response to HCTZ (12.5-25 mg daily for 8 weeks) than men. Women were 57% more likely to reach the control goal of diastolic BP than men [2]. Also a small randomized clinical trial (29 men, 23 women) showed that women had higher systolic/diastolic ambulatory BP response to HCTZ than men after 25 mg daily for 4 weeks [3].

Diuretic response to 50 mg oral HCTZ was measured in healthy volunteers (6 men, 6 women) in a randomized, cross-over study. No clinical relevant sex differences in diuretic response, urine flow rate, potassium exc......

# Pharmacokinetics and dosing No studies with a clinically relevant sex analysis regarding the pharmacokinetics or dosing of hydrochlorothiazide have been found. # Effects Studies report conflicting results on sex differences in response to hydrochlorothiazide (HCTZ ). Results from the randomized, double-blind HANE study (113 men, 102 women) showed similar antihypertensive response rates to HCTZ (12.5-50 mg daily over 48 weeks) between men and women [1]. However, a prospective clinical trial (1209 men, 2326 women) found that women had a better diastolic BP response to HCTZ (12.5-25 mg daily for 8 weeks) than men. Women were 57% more likely to reach the control goal of diastolic BP than men [2]. Also a small randomized clinical trial (29 men, 23 women) showed that women had higher systolic/diastolic ambulatory BP response to HCTZ than men after 25 mg daily for 4 weeks [3]. Diuretic response to 50 mg oral HCTZ was measured in healthy volunteers (6 men, 6 women) in a randomized, cross-over study. No clinical relevant sex differences in diuretic response, urine flow rate, potassium excretion rate and natriuretic response were found [4]. # Adverse effects Large pharmacoepidemiological studies have shown an increased risk of non-melanoma skin cancer (basal cell carcinoma, squamous cell carcinoma) after exposure of increased cumulative doses of HCTZ [5-7]. Men and women had similar risk of lip cancer [5] and basal cell carcinoma [6], while the risk of squamous cell carcinoma (not lip) was higher in women (OR 4.46; 95%CI 4.04-4.94) than in men (OR 3.26; 95%CI 2.85-3.72) [5, 6]. HCTZ-induced acute pulmonary edema has been described as a rare adverse event. In a review of reported cases, 16 out of 17 patients were women [8]. Cases of acute allergic interstitial pneumonitis induced by HCTZ have been described in the literature. In a series of case reports, female sex was reported as a risk factor, since 27 (90%) of the 30 described patients were women, mostly postmenopausal [9].  Hyponatremia is reported to be more common in women treated with HCTZ. A medical record review of patients with hyponatremia treated with diuretics (31 men, 149 women) revealed that women had three times higher risk of hyponatremia than men in all age groups (OR 3.10, 95%CI 2.07-4.67). Almost all received HCTZ (75%). Duration of diuretic treatment was only reported in 57 patients; 44% of the patients had developed hyponatremia within 1 month of treatment and 45% after 6 months [10]. In another review of medical records, female sex was a risk factor for hyponatremia among patients treated with HCTZ or indapamide (391 men and 608 women on HCTZ) [11]. # Reproductive health issues Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan). # Other information Studies have found interacting effects between patient’s sex and ACE genotype on blood pressure response to HCTZ in blacks, whites [12] and Han Chinese patients [13] with hypertension. The genotypes associated with the greatest decline in blood pressure were DD homozygotes in men and II homozygotes in women [12, 13]. A Canadian cohort study evaluating age and sex-related use of thiazide diuretics and beta-blockers showed that women were 8% more likely than men to be dispensed a low-dose thiazide diuretic (OR 1.08, 95% CI 1.05-1.11) [14].
Försäljning på recept

Fler kvinnor än män hämtade ut tabletter innehållande HCTZ (ATC-kod C03AA03) på recept i Sverige år 2018, totalt 41 152 kvinnor och 34 296 män. Det motsvarar 8,2 respektive 6,8 personer per tusen invånare. Andelen som hämtat ut läkemedel var högst i åldersgruppen 70 år och äldre hos båda könen. I genomsnitt var tabletter innehållande HCTZ 1,1 gånger vanligare hos kvinnor [15].
Referenser
  1. Philipp T, Anlauf M, Distler A, Holzgreve H, Michaelis J, Wellek S. Randomised, double blind, multicentre comparison of hydrochlorothiazide, atenolol, nitrendipine, and enalapril in antihypertensive treatment: results of the HANE study HANE Trial Research Group. BMJ. 1997;315:154-9.
  2. Fan X, Han Y, Sun K, Wang Y, Xin Y, Bai Y et al. Sex differences in blood pressure response to antihypertensive therapy in Chinese patients with hypertension. Ann Pharmacother. 2008;42:1772-81.
  3. Falconnet C, Bochud M, Bovet P, Maillard M, Burnier M. Gender difference in the response to an angiotensin-converting enzyme inhibitor and a diuretic in hypertensive patients of African descent. J Hypertens. 2004;22:1213-20.
  4. Franson KL, Kuk JM, Lam NP, Lau AH. Gender effect on diuretic response to hydrochlorothiazide and furosemide. Int J Clin Pharmacol Ther. 1996;34:101-5.
  5. Pottegård A, Hallas J, Olesen M, Svendsen MT, Habel LA, Friedman GD et al. Hydrochlorothiazide use is strongly associated with risk of lip cancer. J Intern Med. 2017;282(4):322-331.
  6. Pedersen SA, Gaist D, Schmidt SAJ, Hölmich LR, Friis S, Pottegård A. Hydrochlorothiazide use and risk of nonmelanoma skin cancer: A nationwide case-control study from Denmark. J Am Acad Dermatol. 2018;78(4):673-681e9.
  7. Läkemedelsverket. Hydroklortiazid - Risk för icke-melanom hudcancer (basalcellscancer, skivepitelcancer). Läkemedelsverket [www]. [updated 2019-10-15, cited 2019-03-12].
  8. Kavaru MS, Ahmad M, Amirthalingam KN. Hydrochlorothiazide-induced acute pulmonary edema. Cleve Clin J Med. 1990;57:181-4.
  9. Biron P, Dessureault J, Napke E. Acute allergic interstitial pneumonitis induced by hydrochlorothiazide. CMAJ. 1991;145:28-34.
  10. Sharabi Y, Illan R, Kamari Y, Cohen H, Nadler M, Messerli FH et al. Diuretic induced hyponatraemia in elderly hypertensive women. J Hum Hypertens. 2002;16(9):631-5.
  11. Al Qahtani M, Alshahrani A, Alskaini A, Abukhalid N, Al Johani N, Al Ammari M et al. Prevalence of hyponatremia among patients who used indapamide and hydrochlorothiazide: a single center retrospective study. Saudi J Kidney Dis Transpl. 2013;24(2):281-5.
  12. Schwartz GL, Turner ST, Chapman AB, Boerwinkle E. Interacting effects of gender and genotype on blood pressure response to hydrochlorothiazide. Kidney Int. 2002;62(5):1718-23.
  13. Li Y, Yang P, Wu S, Yuan J, Shen C, Wu Y et al. Gender-specific association between ACE gene I/D polymorphism and blood pressure response to hydrochlorothiazide in Han Chinese hypertensive patients. Biochem Genet. 2011;49:704-14.
  14. Rochon PA, Anderson GM, Tu JV, Gurwitz JH, Clark JP, Shear NH et al. Age- and gender-related use of low-dose drug therapy: the need to manufacture low-dose therapy and evaluate the minimum effective dose. J Am Geriatr Soc. 1999;47(8):954-9.
  15. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2018 [cited 2019-03-08.]
Uppdaterat

Litteratursökningsdatum 3/8/2019

Litteratursökningsdatum 3/8/2019
A A
A A

Kandesartan

Kandesartan

Klass: A

Produkter

Amias, Atacand, Atacand Plus, Blopresid Comp, Blopress ......

Amias, 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 Bijon, Candesartan/Hydrochlorothiazide Krka, Candesartan/Hydrochlorothiazide Navamedic, Candesartan/Hydrochlorothiazide Orion, Candesartan/Hydrochlorothiazide STADA, Candesartan/Hydrochlorothiazide Teva, Candexetil, Candexetil comp, Etilbo, Kairasec, Kandesartan Ebb, Kandrozid, Racanda, Ratacand Plus
ATC-koder

C09CA06, C09DA06

C09CA06, C09DA06
Substanser

kandesartan, kandesartancilexetil

kandesartan, kandesartancilexetil
Sammanfattning

Den blodtryckssänkande effekten av kandesartan är likvärdig hos kvinnor och män.

Kandesartan minskar risken för kardiovaskulär död och sjukhusinläggning för hjärtsvikt lika effektivt hos kvinnor och män.

Den blodtryckssänkande effekten av kandesartan är likvärdig hos kvinnor och män. Kandesartan minskar risken för kardiovaskulär död och sjukhusinläggning för hjärtsvikt lika effektivt hos kvinnor och män.
Background

Pharmacokinetics and dosing
Pharmacokinetic studies have found no sex differences in the pharmacokinetic parameters of candesartan in hypertensive patients [1-5] or in healthy adults [6]. 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 patient’s sex and weight [5]. Based on the pharmacokinetics of candesartan, no initial dosage adjustment based on patient’s 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) shows a clinically significant dose-dependent antihypertensive effect of candesartan, irrespective of patient’s sex [7].

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.......

# Pharmacokinetics and dosing Pharmacokinetic studies have found no sex differences in the pharmacokinetic parameters of candesartan in hypertensive patients [1-5] or in healthy adults [6]. 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 patient’s sex and weight [5]. Based on the pharmacokinetics of candesartan, no initial dosage adjustment based on patient’s 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) shows a clinically significant dose-dependent antihypertensive effect of candesartan, irrespective of patient’s sex [7]. 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 [8]. 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 these results. However, the effect of candesartan (4-32 mg once daily) was similar in men and women [9]. # 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 patient’s sex [10, 11]. # Reproductive health issues Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).
Försäljning på recept

Nästan lika många kvinnor och män hämtade ut tabletter innehållande kandesartan (ATC-kod C09CA06) på recept i Sverige år 2019, totalt 145 222 kvinnor och 146 101 män. Det motsvarar 29 respektive 28 personer per tusen invånare. Andelen som hämtat ut läkemedel var högst i åldersgruppen 75 år och äldre hos båda könen. I åldersgruppen yngre än 79 år var tabletter innehållande kandesartan i genomsnitt 1,2 gånger vanligare hos män medan i åldersgruppen 80 år och äldre var det i genomsnitt 1,1 gånger vanligare hos kvinnor [12]. Fler män än kvinnor hämtade ut tabletter innehållande kombination av kandesartan och hydroklortiazid (ATC-kod C09DA06) på recept i Sverige år 2019, totalt 33 778 män och 29 478 kvinnor. Det motsvarar 6,6 respektive 5,8 personer per tusen invånare. Andelen som hämtat ut läkemedel var högst i åldersgruppen 65-84 år hos män och i åldersgruppen 70-84 år hos kvinnor. I åldersgruppen yngre än 79 år var tabletter innehållande kombination av kandesartan och hydroklortiazid i genomsnitt 1,9 gånger vanligare hos män och i åldersgruppen 80 år och äldre i genomsnitt 1,2 gånger vanligare hos kvinnor [12].
Referenser
  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.
  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.
  3. Atacand (candesartan cilexetil). DailyMed [www]. US National Library of Medicine. [updated 2018-10-01, cited 2019-10-11].
  4. Gleiter CH, Mörike KE. Clinical pharmacokinetics of candesartan. Clin Pharmacokinet. 2002;41:7-17.
  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.
  6. Food and Drug Administration (FDA). Atacand (candesartan). Drugs@FDA [www]. [updated 2002-04-11, cited 2019-10-11].
  7. 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.
  8. 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.
  9. 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.
  10. Gleiter CH, Jägle C, Gresser U, Mörike K. Candesartan. Cardiovasc Drug Rev. 2004;22:263-84.
  11. 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.
  12. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2019 [cited 2020-03-10.]
Uppdaterat

Litteratursökningsdatum 10/10/2019

Litteratursökningsdatum 10/10/2019